DWIGHT D. SULLIVAN,
COUNTY CLERK
GALVESTON COUNTY, TEXAS
ASSUMED NAME RECORD CERTIFICATE OF OWNERSHIP FOR
UNINCORPORATED BUSINESS OR PROFESSION
Business Name ___________________________________________________________________________________________________
Business Address _________________________________ _____________________ City _________________________ State ________ Zip _______________
Mailing Address _________________________________________________________ City _________________________ State ________ Zip _______________
Business is to be conducted as (check one):
________ Proprietorship ________ Sole Practitioner ________ Joint Venture ________
Joint Stock Company
________ General Partnership ________ Real Estate Investment Trust ________ Other
___________________________________
CERTIFICATE OF OWNERSHIP
NOTICE: Α CERTIFICATES OF OWNERSHIP ARE VALID ONLY FOR A PERIOD NOT TO EXCEED 10 YEARS FROM THE DATE FILED IN THE COUNTY CLERK’S
OFFICE (CHAPTER 36, SEC.1, TITLE 4 - BUSINESS AND COMMERCE CODE) THIS CERTIFICATE PROPERLY EXECUTED IS TO BE FILED
IMMEDIATELY WITH THE COUNTY CLERK.
I/WE, THE UNDERSIGNED, ARE THE OWNER(S) OF THE ABOVE BUSINESS AND MY/OUR NAME(S) AND ADDRESS(ES) GIVEN IS/ARE TRUE AND CORRECT,
AND THERE IS NO OWNERSHIP(S) IN SAID BUSINESS OTHER THAN THOSE LISTED HEREIN BELOW.
Name ___________________________________________________________________ Signature _______________________________________________________________
(PRINT)
Address _____________________________________________________________ City __________________________________ State _______ Zip ______________
Name ___________________________________________________________________ Signature _______________________________________________________________
(PRINT)
Address _____________________________________________________________ City __________________________________ State _______ Zip ______________
Name ___________________________________________________________________ Signature _______________________________________________________________
(PRINT)
Address _____________________________________________________________ City __________________________________ State _______ Zip ______________
The State of Texas, County of Galveston
BEFORE ME, THE UNDERSIGNED AUTHORITY, on this day personally appeared
__________________________________________________________________________________________
________________________________________________________
known to me to be the person whose name is subscribed to the foregoing instrument and, under oath, acknowledged to me that
he/she signed the same for the purpose and consideration therein expressed.
GIVEN UNDER MY HAND AND SEAL OF OFFICE, THIS _________ DAY OF _____________________________________, 20_______
DWIGHT D. SULLIVAN, COUNTY CLERK
GALVESTON COUNTY, TEXAS
By: _______________________________________________________, or
Deputy
____________________________________________________________
Notary Public