Last updated: 2/12/2007
Dissolution Of Assumed Business Name
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Description
ALL INFORMATION MUST BE COMPLETED BEFORE RECORDING DISSOLUTION OF ASSUMED BUSINESS NAME ORIGINAL REFERENCE NO. ________________ 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
