Certification Of Assumed Business Name

CERTIFICATION OF ASSUMED BUSINESS NAME For persons (sole proprietorships, associations, or general partnerships) engaged in business under a name other than their own (DBA) STATE OF INDIANA, COUNTY OF ELKHART NAME OF BUSINESS: __________________________________________________________________________________ NATURE OF BUSINESS: ________________________________________________________________________________ ADDRESS OF BUSINESS:_______________________________________________________________________________ PRINTED NAMES AND RESIDENCES OF MEMBERS OF BUSINESS: _________________________________ At _________________________________________________________________ _________________________________ At _________________________________________________________________ _________________________________ At _________________________________________________________________ I certify that I have personal knowledge of the facts stated above and that each of them are true. SIGNATURE OF BUSINESS MEMBER_____________________________________________________________________ ____________________________________________________ Print Member's Name SECTION TO BE COMPLETED BY/IN PRESENCE OF A NOTARY PUBLIC STATE OF INDIANA SS: ELKHART COUNTY __________________________, personally appeared before me, a Notary Public, has personal knowledge of the above facts stated are true and accurate. Subscribed and sworn to before, a Notary Public this_______day of___________________, 20______. My Commission Expires____________________ County of Residence______________________ ____________________________ Notary Public ­ Signature ____________________________ Notary Public ­ Printed Name This instrument prepared by ________________________________________________ I affirm, under the penalties for perjury, that I have taken reasonable care to redact each Social Security Number in this document, unless required by law. _______________________________ Rev. October 08, 2015 American LegalNet, Inc. www.FormsWorkFlow.com