Assumed Business Name Certificate

Assumed Business Name Certificate 10.03.17 A SSUMED BUSINESS NAME CERTIFICATE (NCGS 247 66 - 71 .5) Please print legibly. 1. The assumed business name is : (You may include no more than five (5) assumed business names on this form.) 2. The real name of the person or entity engaging in business under the assumed business name is : ex act name registered with the NC and the SOSID number assigned at the time of forma tion. Go to www.sosnc.gov/br/search to look up your information. ) 3. The nature /type of the business is : 4. Th e street address of the principal place of business is: (PO Boxes are not acceptable) 5. The mailing address, if different from the street address , is: 6. The counties w h ere the assumed business name will be used to engage in business are : All 100 North Carolina c ountie s T his certificate is signed by the owner/l egal representative of the person or entity named above , this day of , 20. Signature: Printed/Typed Name: Title : ( See instructions for who must sign for various business entity types. ) American LegalNet, Inc. www.FormsWorkFlow.com Instructio ns for ABN Certificate 10.0 3.17 Instructions for Completing an Assumed Business Name Certificate Item 1: Enter the assumed business name(s) you propose to use. You may register up to five (5) assumed business names for use by the same person or entity on this form . Item 2: Enter the name(s) of the person(s) or entity engaging in business under this name. For sole p roprietorships , provide the real name of the individual. For general partnerships , if you h ave fewer than five (5) general partners, list all general partners. If there are five (5) or more general partners, then list only five (5) general partners. For limited partnerships , limited liability limited partnerships, c orporations , lim ited liability companies (LLCs), provide the: E xact name as registered with t he NC Secretary of State , and SOSID number assigned by the NC Secretary of State. Go to www.sosnc.gov/br/search to look up this information . For t rusts , the name specified in the trust instrument. For any other legal entity, list the legal name of the entity. Item 3: Describe the nature of the business. What types of goods or services are being provided? (Examples: Lawn Maintenance, Personal Fitness Training, Retail Sales, House Repair) Item 4: Enter the street address of t he principal place of business, i.e., the physical location of where your business is primarily located. Post office boxes are not acceptable. Item 5: Enter the mailing address, if it is different from the street address of the principal place of business. Item 6: Enter the county or counties where you intend to do business. You may enter the names of as many counti separately. Remember: you must file a certificate of amendment if you decide to engage in business in counties other than those your designate on yo ur initial assumed business name certificate. Execution of Certificate: Enter the date that you signed the certificate. Certificates must be sign ed by a person with the capacity listed below on behalf of the person(s) named in Item 2: S ole proprietor ship : must be signed by the individual General Partnership : must be signed by a general partner. L imited partnership : must be signed by a general partner . Corporation : must be signed by an officer of the corporation . Lim ited Liability Company : must be signed by a manager, member, director or officer of the LLC. Trust : must be signed by a trustee or other person authorized to act on behalf of the trust . In the case of any other legal entity , the certificate must be signed in the name of the entity by an individual authorized to act for the entity . Please note: 1. These certificates do not expire or require renewal. HOWEVER , y ou must file a n Amendment of Assumed Business Name Certificate within sixty (60) days of change of any information provided on this form. (See NCGS 247 66 - 71.7) 2. Knowingly signing a certificate that is false in any material respect is a Cla ss 1 misdemeanor. (See NCGS 247 66 - 71.14) American LegalNet, Inc. www.FormsWorkFlow.com