Registration Of Fictitious Name Form - Missouri Secretary Of State
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1
2State of Missouri
No. X_________________
Matt Blunt, Secretary of State
Corporations Division
Registration of Fictitious Name
(Submit in duplicate with filing fee of $7)
)
(Must be typed or printed
This information is for the use of the public and gives no protection to the name. There is no provision in this Chapter to
keep another person or business from adopting and using the same name. (Chapter 417, RSMo.)
We, the undersigned, are doing business under the following name, and at the following address:
Business name to be registered:
________________________________________________________________________
Business Address:
________________________________________________________________________
(P.O. Box alone not acceptable)
City, State and Zip Code:
________________________________________________________________________
The parties having an interest in the business, and the percentage they own are (if a business entity is owner, indicate
business name and percentage owned. If all parties are jointly and severally liable, percentage of ownership need not be listed):
If listed,
Percentage
Name of Owners,
State
of ownership
Individual or
and
must equal
Business Entity
Street and Number
City
Zip Code
100%
_______________________________ ________________________ ____________________ __________
__________
_______________________________ ________________________ ____________________ __________
__________
_______________________________ ________________________ ____________________ __________
__________
_______________________________ ________________________ ____________________ __________
__________
_______________________________ ________________________ ____________________ __________
__________
_______________________________ ________________________ ____________________ __________
__________
Return to: Secretary of State
Corporations Division
P.O. Box 778
Jefferson City, Mo. 65102
(Over)
Corp. #56 (11/00)
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