Assumed Business Name - Amendment
Secretary of State - Corporation Division - 255 Capitol St. NE, Suite 151 - Salem, OR 97310-1327 - sos.oregon.gov/business - Phone: (503) 986-2200
In accordance with Oregon Revised Statute 192.410-192.490, the information on this application is public record.
We must release this information to all parties upon request and it will be posted on our website. For office use only
Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary.
CURRENT BUSINESS NAME:
DESCRIPTION OF BUSINESS:
PRINCIPAL PLACE OF BUSINESS: (Street Address, City, State, Zip)
NAME OF AUTHORIZED REPRESENTATIVE: (One name only)
MAILING ADDRESS OF AUTHORIZED REPRESENTATIVE:
10. SIGNATURE(S): New Registrants must sign. If any Registrants are WITHDRAWING, withdrawing Registrants or Authorized Representative must sign.
CONTACT NAME: (To resolve questions with this filing)
PHONE NUMBER: (Include area code)
If Changing Business Name $50
No Fee For Other Changes
Processing Fees are nonrefundable. Please make check payable to "Corporation Division".
Free copies are available at sos.oregon.gov/business using the Business Name Search program.
Assumed Business Name - Amendment (11/17)
NEW BUSINESS NAME: (If changed, $50 fee required)
CONTINUING or NEW
Complete only the sections that you are updating.
To review current information, please go to: sos.oregon.gov/bizsearch
Fax: (503) 378-4381
Registrant Name Street Address City State Zip
CURRENT REGISTRANTS/OWNERS ADDRESS CHANGE ONLY:
(This section is only for registrant address changes)(Attach separate sheet if needed)
b. WITHDRAWING REGISTRANTS/OWNERS:
(List name and publicly available street address of new registrants)(Attach separate sheet if needed)
a. NEW REGISTRANTS/OWNERS: Street Address City State Zip
I declare as an authorized signer, under penalty of perjury, that this document does not fraudulently conceal, obscure, alter, or otherwise
misrepresent the identity of any person including officers, directors, employees, members, managers or agents. This filing has been examined by
me and is, to the best of my knowledge and belief, true, correct and complete. Making false statements in this document is against the law and may
be penalized by fines, imprisonment, or both.