Registration Of Fictitious Name Form - Missouri Secretary Of State (Page 2 of 2) in pdf

Registration Of Fictitious Name Form - Missouri Secretary Of State Page 2

The undersigned, being all the parties owning interest in the above company, being duly sworn, upon their oaths each did say

that the statements and matters set forth herein are true.

Individual

X___________________________________ X___________________________________

{

Owners

Sign Here

X___________________________________ X___________________________________

Business Entity

_____________________________________________________________________

{

Business Name

Owner,

Authorized

_____________________________________________________________________

Person

Authorized Signature

Printed Name

Title

Execute

Here

State of Missouri

}

County of _______________________________

I, ___________________________________, A Notary Public, do hereby certify that on __________________________

month/day/year

personally appeared before me _______________________________________, and being duly sworn by me, acknowledged that

he/she signed as his/her own free act and deed the foregoing document in the capacity therein set forth and declared that the statements

therein contained are true.

IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year before written.

(Notarial Seal or Stamp)

_______________________________________________________

Notary Public

_______________________________________

My commission expires

_____________________________________

My County of Commission

Corp. #56 (11/00)

Registration Of Fictitious Name Form - Missouri Secretary Of State Page 2