Assumed Name Certificate Form

Assumed Name Certificate Form

This Assumed Name Certificate is executed by Registrant Name: and Co-Registrant Name: for the purpose of registering and certifying an assumed name under applicable law.

RECITALS

WHEREAS, Registrant conducts or intends to conduct business under the assumed name Assumed Business Name: ; and

WHEREAS, Registrant and Co-Registrant desire to provide the facts required to be submitted to the appropriate registering authority and to make the certifications herein contained; and

WHEREAS, the statements made in this Certificate are made for the purpose of compliance with statutes and local regulations governing the registration and public notice of assumed or fictitious business names.

NOW, THEREFORE

In consideration of the foregoing recitals and intending to be legally bound, Registrant and Co-Registrant hereby certify and declare under penalty of perjury as follows:

1. NAME AND ENTITY TYPE

1.1 The assumed name to be registered is: .

Individual / Sole Proprietor
Partnership
Corporation
Limited Liability Company
Other:

2. PRINCIPAL PLACE OF BUSINESS

3. ENTITY INFORMATION AND OWNERS

3.1 State or jurisdiction of formation (for entity): . Registration or file number (if applicable):

4. NATURE OF BUSINESS AND TERM

4.1 Date on which Registrant first used the assumed name in this jurisdiction: .

4.2 This assumed name registration shall remain in effect until terminated in accordance with law or until the registrant files a cancellation: Perpetual If limited, end date:

5. STATEMENT, CERTIFICATION AND OATH

5.1 Registrant and Co-Registrant hereby declare, under penalty of perjury, that the information contained in this Certificate is true and correct to the best of their knowledge and that the assumed name is not used for any fraudulent purpose and does not infringe any existing protected name or trademark.

5.2 Registrant acknowledges that making a false statement on this Certificate may subject the registrant to civil or criminal penalties as provided by law, including but not limited to fines and injunctive relief.

6. NOTICES

All notices, process, and official communications required or permitted under this Certificate shall be sent to the address of the principal place of business set forth above or to the mailing address provided herein.

7. GENERAL PROVISIONS

Governing Law: This Certificate shall be governed by and construed in accordance with the laws of the jurisdiction in which it is filed. Any dispute concerning the construction or enforcement of this Certificate shall be determined by the courts of that jurisdiction.

Entire Agreement: This Certificate, together with any attachments, constitutes the entire statement of facts and agreement concerning the registration of the assumed name and supersedes all prior statements and understandings, whether written or oral, relating to the subject matter hereof.

Severability: If any provision of this Certificate is held invalid or unenforceable by a court of competent jurisdiction, the remaining provisions shall continue in full force and effect to the maximum extent permitted by law.

Amendments and Waiver: No amendment or waiver of any provision of this Certificate shall be effective unless in writing and signed by the party or parties to be charged. The waiver by any party of a breach shall not constitute a waiver of any subsequent breach.

SIGNATURES

The undersigned declare under penalty of perjury under the laws of the jurisdiction in which this Certificate is filed that they are authorized to execute this Certificate and that the information contained herein is true and correct.

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