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BUSINESS REGISTRATION CERTIFICATE

PERSON CONDUCTING BUSINESS UNDER ASSUMED NAME OR PARTNERSHIP

County of Allegan, Office of County Clerk

113 Chestnut Street, Allegan, MI 49010

The Undersigned hereby certifies, under provisions of P.A. 111 of 1990, as amended, that I/We now own, conduct

transact

business in the County of Allegan, State of Michigan, under the name designation set forth below:

Please



ASSUMED NAME

CO-PARTNERSHIP

CHANGE

DISSOLUTION

Select

OF LOCATION

One:

NAME OF BUSINESS:___________________________________________________________________________

ADDRESS OF BUSINESS (

)_________________________________________________________

NO Post Office Box

(Street)

__________________________________________________________

(City, State, Zip)

MAILING ADDRESS (

):_______________________________________________________

IF DIFFERENT THAN ABOVE

DAYTIME PHONE NUMBER:______________________________________________________________________

NAME OF PERSON OR PERSONS, OWNING, CONDUCTING, TRANSACTING, OR COMPOSING THE ABOVE BUSINESS,

AND THE HOME POST OFFICE ADDRESS OF EACH

NAME OF PERSON

RESIDENCE ADDRESS (Street, City, State, Zip)

(Print)_______________________________________________________________________________________________

STOP ---- MUST BE SIGNED IN PRESENCE OF A NOTARY PUBLIC

SIGNATURES OF ALL PERSONS LISTED BELOW MUST BE NOTARIZED:

(Signature)_________________________________________ (Signature)__________________________________________

---------------------------------------------------------NOTARY SECTION ONLY-------------------------------------------------------------

STATE OF MICHIGAN

Subscribed and sworn to before me this________day of________________________, 20______by all persons listed above.

COUNTY OF ALLEGAN

_______________________________________________________________

(Signature)

(Print)__________________________________________________________________________

Notary Public, Allegan County, Michigan.

:______________________________________________________

My Commission Expires

THIS CERTIFICATE EXPIRES FIVE (5) YEARS FROM THE DATE OF FILING WITH COUNTY CLERK

(This portion to be filled in only by the County Clerk)

I, Bob Genetski, Clerk of the County of Allegan and the Circuit Court thereof, do hereby certify that I have

STATE OF MICHIGAN

Certificate

compared the foregoing copy of Business Registration

with the original of record in my office, and that

COUNTY OF ALLEGAN

the same is a correct transcript therefrom, and of the whole of such original. IN TESTIMONY WHEREOF, I have

hereunto set my hand and affixed the seal of said Circuit Court, at the City of Allegan, this:

____________day of_____________________________________________20_________.

Bob Genetski, Allegan County Clerk

By:_________________________________________________

COUNTY CLERK/DEPUTY COUNTY CLERK

DBA FORM 0816rev

Dba Form 0816 - Business Registration Certificate Person Conducting Business Under Assumed Name Or Partnership

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