Office of the Minnesota Secretary of State
Consent to the Use of Name
Read the instructions before completing this form.
Filing Fee: $55 for expedited service in-person, $35 for mail
1. Name you wish to register: (Required)
2. Name already on file: (Required)
3. Address of business already on file: (Required)
Street Address City State Zip Code
I grant consent to register the name listed on line 1 to:
(List the name of the person or entity registering the new name)
Located at:
City State Zip Code
Street Address
(Check one)
with the following conditions: NOTE: Conditions must be privately enforced.
5. I, the undersigned, certify that I am
signing this document as the person whose signature is required, or as agent of the
person(s) whose signature would be required on behalf of the previous holder of this name, who has authori
zed me to
sign this document on his/her behalf. I further certify that I have completed all required fields, and that the information in
this document is true and correct and in compliance with the applicable chapter of Minnesota Statutes. I understand that
by signing this document I am subject to the penalties of perjury as set forth in Section 609.48 as if I had signed this
document under oath.
Signature of Authorized Person or Authorized Agent Date
Print Name and Position
List a name and daytime phone number of a person who can be contacted about this form:
Contact Name Phone Number
Note: Information provided when filing a business entity is public data and may be viewable online. This includes but is
not limited to all individual names and addresses.
Please complete this form if the business name you wish to register is already registered with this office by another. If
you are unable to locate the holder of the name already on file, you may be able to file an Abandoned Name Affidavit.
Submit this form along with the original filing or amendment you wish to record. Complete one form for each
name already on file.
Retain the original signed copy of this document for your records and submit a legible photocopy for filing with the
Office of the Secretary of State.
1. List the business name you wish to register. (Required)
2. List the business name on file with this office that is in conflict with the name y
ou are filing. (Required)
3. List the address of the business on file with this office. (Required)
4. The next section must be completed by the holder of the name that is already on file with this office. (Required)
5. Signature of authorized representative or agent (The signing party must indicate on the document that they are
acting as the agent of the person(s) whose signature would be required and that they have been authorized to sign
on behalf of that person(s).)
List a name and daytime telephone number of a person who can be contacted about this form.
Filing Fee: $55 for expedited service in-person, $35 if submitted by mail
Payable to the MN Secretary of State
Please submit all items together and mail to the address below:
Minnesota Secretary of State - Business Services
Retirement Systems of Minnesota Building
60 Empire Drive, Suite 100
St Paul, MN 55103
(Staffed 8 a.m. – 4 p.m., Monday - Friday, excluding holidays)
Phone Lines: (9 a.m. - 4 p.m., M-F) Metro Area 651-296-2803; Greater MN 1-877-551-6767
All of the information on this form is public. Minnesota law requires certain information to be provided for this type of
filing. If that information is not included, your document may be returned unfiled. This document can be made available
in alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf
and hard of hearing) communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a
call to (651)296-2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual
orientation, national origin, age, marital status, disability, religion, reliance on public assistance or political opinions or
affiliations in employment or the provision of service.