ASSUMED NAME CERTIFICATE FOR CERTAIN UNINCORPORATED PERSONS
ASSUMED NAME under which the business or professional service is or is to be conducted (print clearly):
PHYSICAL ADDRESS OF BUSINESS (print clearly):
Form of identification presented:
Address
City State Zip Code
I hereby state that this registrant is:
Signature of Notary Public in and for the State of Texas or Clerk of the Court, Deputy Seal of the Notary Public or Clerk of the Court, Deputy
INFORMATION WHERE DOCUMENT SHOULD BE RETURNED
(to be completed by applicant):
In the spaces below, clearly print the name, address, city, state, and zip code where
this document should be returned
AN INDIVIDUAL. Below is my full name and residence address.
A PARTNERSHIP. Below is the name and office address of the venture or partnership; the full name of each joint venture or general partner;
and each joint venturer’s or general partner’s office address, if the venture or partner is not an individual.
AN ESTATE. Below is the name and address (if any) of the estate; the full name of each representative of the estate; and each representative’s
residence address if the representative is an individual, or the representative’s office address, if the representative is not an individual.
A REAL ESTATE INVESTMENT TRUST. Below is the name and address of the trust; the full name of each trustee manager; and each
trustee manager’s residence address, if the trustee manager is an individual, or the trustee manager’s office address, if the trustee manager is
not an individual.
COMPANY OTHER THAN A REAL ESTATE INVESTMENT TRUST. Below is the name and office address of the company. The state,
country, or other jurisdiction under the laws of which this company was organized is
And further state that this registrant is not a limited partnership, limited liability company, limited liability partnership, or foreign filing entity.
Information required as listed above (print clearly):
Name
Signature
Address
Name
Signature
Address
Name
Signature
Address
FOR USE BY NOTARY AND CLERK OF THE COURT, DEPUTY. The State of Texas and County of Grimes:
Before me, the undersigned authority, on this day personally appeared:
known to me to be the person(s) whose name(s) is/are subscribed to the foregoing instrument and acknowledged to me that he/she/they signed the
same purpose and consideration therein expressed. Given under my hand and seal of office, on
Phone: (936) 873-4410
www.grimescountytexas.gov
Mailing Address: P.O. Box 209, Anderson, Texas 77830
Vanessa Burzynski Grimes County Clerk
Filing Fee is $26.00 Make Checks Payable to Grimes County Clerk Call to pay by credit card.
