WARNING: The filing of this application and its approval by the Division does not authorize the use in the state of Utah of an assumed
name in violation of the rights of another under federal, state, or common law (U.C.A. Section 42-2-5 Et seq.).
*When approved the DBA is registered for 3 years.
*If adding or removing an Applicant/Owner, which will affect its status as a General Partnership or Sole Proprietorship, you must submit a
Registration Information Change Form
.
*If
you want a new name
(adding or changing the existing name), a new DBA filing is required.
Non-Refundable Processing Fee: [ ] New Filing $22.00 [ ] Applicant/Owner Transfer N/A
Requested Business Name:
Business Purpose:
Business Address:
______________________________________________________________________
Address City State Zip
Who/What is the name of the Registered Agent (Individual or Business Entity or Commercial Registered Agent)?:
________________________________________________________________________________________
The address must be listed if you have a non-commercial registered agent. See instructions for further details.
Address of the Registered Agent: ___________________________________________________________
Utah Street Address Required, PO Boxes can be listed after the Street Address
City: State UT Zip:
Applicant/Owner:
List the individual or business
entity that will own the DBA on
the name line.
(The registered agent will be
recorded as the applicant/owner if
this section is left blank)
Name: _______________________________________________________________________________
Entity Number (if a registered business): ____________________________________________________
Address: _____________________________________________________________________________
City: __________________________________________________ State: ________ Zip: ____________
Under penalties of perjury, I declare that this DBA Application has been examined by me and is, to the best of my
knowledge and belief, true, correct and complete
.
Signature:
Applicant/Owner:
List the individual or business
entity that will own the DBA on
the name line.
If needed, you may use an
attached sheet for additional
applicants
Name: _______________________________________________________________________________
Entity Number (if a registered business): ____________________________________________________
Address: _____________________________________________________________________________
City: __________________________________________________ State: ________ Zip: ____________
Under penalties of perjury, I declare that this DBA Application has been examined by me and is, to the best of my
knowledge and belief, true, correct and complet
e.
Signature:
Under GRAMA {63G-2-20
1}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use
the business entity physical address rather than the residential or private address of any individual affiliated with the entity.
Optional Inclusion of Ownership Information: This information is not required.
Is this a female owned business? Yes No
Is this a minority owned business? Yes No If yes, please specify:
State of Utah
Department of Commerce
Division of Corporations & Commercial Code
Business Name Registration / DBA Application
This form cannot be hand written.
Link to DBA Transfer form
What is a commercial registered agent?
Sign here after the form is printed
Sign here after the form is printed
Mailing/Faxing Information:
www.corporations.utah.gov/contactus.html
Select/Type the race of the owner here
www.corporations.utah.gov
