Fillable CERTIFICATE OF ASSUMED BUSINESS NAME (City of Oakland)

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CERTIFICATE OF ASSUMED BUSINESS NAME (City of Oakland)

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CERTIFICATE OF ASSUMED BUSINESS NAME
STATE OF INDIANA, COUNTY OF MARION
NAM
E OF BUSINESS:_________________________________________________________________________________
NATURE OF BUSINESS:_______
_________________________________________________________________________
ADDRESS OF BUSINESS:___
____________________________________________________________________________
_________________________________at_________________________________________________________
(name of member) (physical street address, city, state zip)
_______
__________________________at_________________________________________________________
(name of member) (physical street address, city, state zip)
_______
__________________________at_________________________________________________________
(name of member) (physical street address, city, state zip)
SECTION TO BE COMPLETED BY/IN PRESENCE OF NOTARY PUBLIC:
I hereby certify that I have personal knowledge of the facts stated above and that each of them are true.
_______
__________________________________
Member’s Signature
______________________________________
Name
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. (IC 36-2-11-15) FORM PREPARED BY:
_____________________________________________________________ (name of individual)
STATE OF INDIANA, COUNTY OF MARION
Before me, the undersigned, a Notary Public, in and for said County and State, this _____________________ day of
_________________________________, ___________________________, personally appeared
___________________________________________________________________________________________________________,
said person being over the age of 18 years, and acknowledged the execution of the foregoing instrument.
_________________________________________________
Notary Public Signature
Printed Name: _____________________________________
My commission expires: ______________________________
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CERTIFICATE OF ASSUMED BUSINESS NAME (City of Oakland)

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Completed 2 December 2020

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