Assumed Business Name - New Registration
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
REGISTRY NUMBER:
Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary.
1.
ASSUMED BUSINESS NAME: (To be registered)
2.
DESCRIPTION OF BUSINESS: (Primary business activity)
3.
PRINCIPAL PLACE OF BUSINESS: (Street Address, City, State, Zip)
4.
WHO IS AUTHORIZED TO REPRESENT THE OWNERS:
(Authorized Representative) (One name only)
MAILING ADDRESS OF AUTHORIZED REPRESENTATIVE:
NAMES OF OWNERS (REGISTRANTS) AND PUBLICLY AVAILABLE ADDRESSES: (List name and street address of each person or entity who will
conduct or transact business under the assumed business name.) (Attach a separate sheet if necessary.)
Name Street Address City State Zip
8. EXECUTION/SIGNATURE(S): (All owners/registrants must sign)
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.
Signature: Printed Name:
CONTACT NAME: (To resolve questions with this filing)
PHONE NUMBER: (Include area code)
FEES
Required Processing Fee $50
Assumed Business Name filings are good for 2 years
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 - New Registration (11/17)
Registration or filing of a name does not grant exclusive rights or interests in that name. A name may be available for registration; however, someone else may hold a prior right to that
name, or the name may be too similar to another, and may result in a case of legal action brought against the registrant for dilution or unfair competition of someone else's business.
6.
5.
7. COUNTIES:
ALL COUNTIES
(Statewide)
Baker
Benton
Clackamas
Clatsop
Columbia
Coos
Crook
Curry
Deschutes
Douglas
Gilliam
Grant
Harney
Hood River
Jackson
Jefferson
Josephine
Klamath
Lake
Lane
Lincoln
Linn
Malheur
Marion
Morrow
Multnomah
Polk
Sherman
Tillamook
Umatilla
Union
Wallowa
Wasco
Washington
Wheeler
Yamhill
