Certificate Of Assumed Business Name (DBA)

ALL INFORMATION MUST BE COMPLETED BEFORE RECORDING CERTIFICATE OF ASSUMED BUSINESS NAME (DBA) For individuals, (sole proprietorships), Firms, Partnerships or Limited Liability Companies engaged in business under a name other than their own STATE OF INDIANA, COUNTY OF ST JOSEPH Name of Business: ____________________________________________________ Kind of Business: _____________________________________________________ Address of Business: __________________________________________________ Street, City, State and Zip Code Printed names & complete residence addresses of members of business: _________________________ at ________________________________________ _________________________ at ________________________________________ _________________________ at ________________________________________ _________________________ at ________________________________________ I hereby certify that I have personal knowledge of the facts stated above and that each of them are true. _________________________ ___________________________ _________________ Signature Printed Name Capacity of Signer Form prepared by: _________________________________________________ Print name This completed form must be filed in the office of the County Recorder of each county in which a place of business or office is located. ___________________________ Date of Document ____________________________________ Recorder's Signature & Seal