Prepared by: ___________________________________________________ ________________________________________________________ __________________________________
Individual’s Name Street Address City / State / Zip Phone
___________________________________________________________________________________________________________________________________________
Return Documents to:
___________________________________________________________________________________________________________________________________________
TRADE NAMES
Verified statements of person or co-partnership conducting a business under a trade name or assumed name. (Chap-
ter 547, Code of Iowa)
STATE OF IOWA, _______________________________________ County, ss.
I (we) ______________________________________________________________________________________________
_____________________________________________________________________________________________________
in compliance with the provisions of Chapter 547, Code of Iowa, being duly sworn depose and say that the business
conducted, or to be conducted under the trade name of __________________________________________________
______________________________________________________________________ the business address of which is
_____________________________________________________ Street, __________________________________ Iowa in
the above named county, is owned by the following person(s):
Name of Persons Owning
P.O. Address Residence Address
or Having Any Interest in the Business
_________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
and we hereby establish or amend as follows:
Establish Trade Name _____________________________________________________________________________
file or document #___________________________________________________ Date ________________________
Dissolve _________________________________________________________________________________________
Original file or document # __________________________________________ Date ________________________
Withdrawal of name(s) of Partner(s) ___________________________________________________________________
________________________________________________________________________________________________
Original file # ______________________________________________________ Date ________________________
Add name(s) of Partner(s) _________________________________________________________________________
________________________________________________________________________________________________
Original file # ______________________________________________________Date ________________________
Change of Address ______ Business ______ Home
______________________________________________________________________________
______________________________________________________________________________
_______________________________________________________________________
And that there is no one except those mentioned in the foregoing list who owns or has any interest in the above
named business.
_________________ further certify that a corrected statement will be filed in the future each time there may be any
change in ownership, as provided by section 547.2, Code of Iowa.
Signed this __________________________________ day of ____________________________ , _____________ .
_________________________________________________ _________________________________________________
_________________________________________________ _________________________________________________
_________________________________________________ _________________________________________________
Subscribed in my presence and sworn to before me by the said _____________________________________________
____________________________________________________________________________________________________
this _________________________________ day of ____________________________ , _____________ .
____________________________________________________________
_______________________________________ in and for ______________________________________ County, Iowa.
