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
NAME OF BUSINESS: __________________________________________________________________________
TYPE OF BUSINESS: ___________________________________________________________________________
ADDRESS OF BUSINESS: ________________________________________________________________________
___________________________________ at ______________________________________________________
(printed/typed name of member) (physical street address, city, state zip)
___________________________________ at ______________________________________________________
(printed/typed name of member) (physical street address, city, state zip)
___________________________________ at ______________________________________________________
(printed/typed name of member) (physical street address, city, state zip)
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) DOCUMENT PREPARED BY:
_____________________________________________________________
(Printed/typed name of individual)
SECTION TO BE COMPLETED 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
_____________________________________
Printed/Typed Name
STATE OF INDIANA, COUNTY OF ____________________________
Before me, the undersigned, a Notary Public, in and for said County and State, this ____________________________ (date)
personally appeared ___________________________________________________________________________________,
said person(s) 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 28 October 2021

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