CONDUCT OF BUSINESS UNDER FICTITIOUS OR ASSUMED NAMED
Date: ___________________
To: ____________________________________________
State of: ___________________
Pursuant to _________________, relating to the conduct of business under ___________________ name, the undersigned, hereby present(s) for filing the following application in the office of:
1. The name under which the business is, or will be, carried on is:
2. The real name and address of each person owning or interested in the business is:
3. The nature of the business is:
4. The business will be conducted at:
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)
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