Application For Registration Of A Trade Name (Page 2 of 2) in pdf

FORM - TNLLC12

NITED

TATES

IRGIN

SLANDS

OFFICE OF THE LIEUTENANT GOVERNOR

DIVISION OF CORPORATIONS AND TRADEMARKS

APPLICATION FOR REGISTRATION OF TRADE NAME

UNDER A LIMITED LIABILITY COMPANY

VIRGIN ISLANDS CODE – TITLE 11 – CHAPTER 21

FOR OFFICIAL USE ONLY

LAST NAME OF THE MANAGER or MEMBER

DATE RECEIVED

FIRST NAME OF THE MANAGER or MEMBER

RECEIVED BY

MAILING ADDRESS

PAYMENT AMOUNT RECEIVED

PAYMENT TYPE

EMAIL ADDRESS

RECEIPT NO.

BEST DAYTIME CONTACT NUMBER(S)/CELL PHONE

TERRITORY or STATE OF

________________________________________________________ )

JUDICIAL DISTRICT or COUNTY OF

________________________________________________________ )

THIS IS TO CERTIFY THAT ________________________________________________________________________________________________________________________

a limited liability company, organized under the laws of _________________________________________________________________________, the principal

office of which is located at __________________________________________________________________, is doing or intends to do business in the United

States

Virgin

Islands

and

that

this

business

known

the

designation,

name

style

________________________________________________________________,

that

said

business

located

________________________________________________________________________, and that the kind of business to be conducted under said name is

____________________________________________________________________________________________________________________________.

IN WITNESS WHEREOF, THE SAID LIMITED LIABILITY COMPANY ___________________________________________________________________________ has to

these

presents

and

caused

the

name

subscribed

and

acknowledged

its

______________________________________________________________________ at the city of _______________________________ in the state (district) of

_____________________________________ on the ______________ day of _________________________________, __________.

I DECLARE, UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE UNITED STATES VIRGIN ISLANDS, THAT ALL STATEMENTS CONTAINED IN THIS APPLICATION, AND ANY ACCOMPANYING

DOCUMENTS, ARE TRUE AND CORRECT, WITH FULL KNOWLEDGE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE SUBJECT TO INVESTIGATION AND THAT ANY FALSE OR DISHONEST

ANSWER TO ANY QUESTION MAY BE GROUNDS FOR DENIAL OR SUBSEQUENT REVOCATION OF REGISTRATION.

___________________________________________________

Limited Liability Company

MANAGER

MEMBER

________________________________________________

___________________________________________

Printed Name

________________________________________________

___________________________________________

Signature

ACKNOWLEDGEMENT