Office Use_____________
Approved by:_____________
Please mail registration to:
Betsey Bayless
Secretary of State
Trade Name Division
1700 West Washington 7th Floor
Phoenix, Arizona 85007
602/542-6187
Filing Fee: $10.00
ASSIGNMENT OF TRADE NAME
Please print clearly or type to avoid errors in registration. Your renewal notices are dependent on
accurate information including suite numbers. Remember to update your record if you move.
Be it known for good and valuable consideration in hand paid, the receipt of which is hereby
acknowledged, the Assignor identified below together with the good will of the business in connection with
which the said trade name is used by these present does sell, assign and transfer unto the Assignee
identified below the entire right, title and interest in and to the trade name identified below:
1.
Trade Name:
Registration Number:
2.
Assignor:
Trade Name Owner on File
Business Address
Street or Box Number
City
State
Zip
Phone number (optional):
3.
Assignee:
Business Address:
Street or Box Number
City
State
Zip
Mailing Address:
Street or Box Number
City
State
Zip
Phone number (optional):
Assignee: Please check one. Do not select “Corporation or L.L.C. if you are not currently
incorporated, or your application will be returned to you.
Person
Firm
Foundation
Foreign corporation
Partnership
Association
Federation
licensed to do
business
Corporation
LLC
Organization
in Arizona
Assignor’s Printed Name
Assignor’s Signature
Date