Revised 9/20/2018
REGISTRATION OF ASSUMED BUSINESS NAME
STATE OF LOUISIANA
PARISH OF ST. TAMMANY
Before me, the undersigned authority, personally came and appeared
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who after being by me first duly sworn did depose and say:
That they are operating a business under the assumed name of
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and that the address of the affiant is:
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Affiant Signature
Sworn to and subscribed before me this
___________ day of ___________________________, 20_____.
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Notary Public