Fill and Sign the 805 Ilcs 405 Assumed Business Name Act Illinois General Form

NOTICE UNDER ASSUMED BUSINESS NAME ACT STATE OF ILLINOIS ) ) COUNTY OF SANGAMON ) To Whom It May Concern: Notice is hereby given that on the _____ day of _________________, _______ a Certificate of Ownership of Business was filed in the Office of the County Clerk of Sangamon County, stating that: (list owners’ names-submit attachments if needed) ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ intend to transact, or are transacting business in Sangamon County, State of Illinois, under the fictitious name to wit: (list business name) ________________________________________________________________________ and that they are the sole owner(s) and proprietor(s) of said business, and that the principal place of said business is located at: (list full business address) _______________________________________________________________________. ______________________________ Signature of Owner ______________________________ Print Name Owner’s home address: ______________________________________________________ Daytime phone:( )________________ CERTIFICATE OF OWNERSHIP OF BUSINESS NAME OF BUSINESS:___________________________________________________ ADDRESS OF BUSINESS:_____________________________________________________________ Street City State Zip BUSINESS PHONE: ______________________ PUBLISH IN:(check one) ____ State Journal-Register or ____ Illinois Times STATE OF ILLINOIS ) ) SS COUNTY OF SANGAMON ) The following is a true and full report of the names and addresses of all persons owning, conducting or transacting the business named above: NAME OF OWNER STREET ADDRESS CITY, STATE, ZIP STATE OF ILLINOIS ) ) SS COUNTY OF SANGAMON ) being duly sworn, upon oath deposes and says that the foregoing is a true and correct report of the real full name or names of the person or persons owning, conducting or transacting the business named above together with their post office addresses. __________________________________ Signature of Owner Subscribed and sworn to before me this ______ day of ________________, ______ ________________________________________ Notary Public or County Clerk