Fictitious or Assumed Name Certificate by A Corporation : Please fill out the following form. Please print your completed form if you would to have a copy for your records.

CERTIFICATE


The following is hereby certified :


1. Business is or will be transacted at (ADDRESS) under the (Fictitious or Assumed) name of (Name of Business) a corporation incorporated under the laws of (state) andauthorized to transact business in the State of (state) with its main office located at (ADDRESS).


2. The Nature of the business is (Nature of the business).


3. The corporation is the sole owner of the business and no other corporation or entity is interested in the conduct of said business.


This certificate is executed and filed pursuant to:


Date :


STATE OF :


COUNTY OF :


On _________________________ before me ________________________ personally appeared ___________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.


WITNESS my hand and official seal.


Signature :


Affiant : Known / Unknown


ID Produced :


Seal :


NOTE : If you live in New York State, call the New York State Department of Corporation for theofficial form.





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