# ______________________
CERTIFICATE OF TRADE NAME
MIDDLESEX COUNTY, NJ
Please Print or Type Clearly
THE UNDERSIGNED HEREBY CERTIFIES THE FOLLOWING:
1. THE NAME UNDER WHICH THE UNDERSIGNED IS ABOUT TO TRANSACT BUSINESS.
2. THE LOCATION WHERE THE SAID BUSINESS WILL BE CONDUCTED.
3. THE TYPE OF BUSINESS TO BE CONDUCTED BY THE UNDERSIGNED.
4. THE FULL NAME(S) AND ADDRESSES OF EACH PERSON(S) CONNECTED WITH THE SAID BUSINESS OWNER(S).
BUSINESS INFORMATION
Trade Name: _________________________________________________________________________________
Business Address: _________________________________________________________________________________
Town: _____________________________________________________ Zip Code: __________________
Description of Business: ______________________________________________________________________________
OWNER(S) INFORMATION
(Do Not Sign Or Take The Oath Until in the Presence of a Notary Public)
Owner #1 Name: ________________________________________________________________________________
Residence: ________________________________________________________________________________
City/State/Zip: ________________________________________________________________________________
Signature: ________________________________________________________________________________
Owner #2 Name: ________________________________________________________________________________
Residence: ________________________________________________________________________________
City/State/Zip: ________________________________________________________________________________
Signature: ________________________________________________________________________________
Owner #3 Name: _________________________________________________________________________________
Residence: ________________________________________________________________________________
City/State/Zip: ________________________________________________________________________________
Signature: ________________________________________________________________________________
Owner #4 Name: ________________________________________________________________________________
Residence: ________________________________________________________________________________
City/State/Zip: ________________________________________________________________________________
Signature: ________________________________________________________________________________
To be completed only if any of the owner(s) live out of state:
We do hereby appoint the County Clerk of the County of Middlesex, in the State of New Jersey, and her successors in office,
our attorney in fact, upon whom may be served all process affecting the aforesaid business and trade name.
And we do further agree that any process against the aforesaid County Clerk so served, shall be of the same effect as if duly
served upon us within this State.
STATE OF NEW JERSEY
COUNTY OF MIDDLESEX
Being duly sworn, say that all of the above person(s) named in the foregoing certificate swore before me that the statements
contained therein are true, accurate and complete. Subscribed and sworn to before me this
_____________________ day of ______________________________________________ ,20 ___________
