Certificate Of Assumed Name Renewal - Minnesota Secretary Of State
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MINNESOTA SECRETARY OF STATE
feature. Once your form is
completed, be sure to select "Print"
CERTIFICATE OF ASSUMED NAME RENEWAL
at the bottom of the screen to
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After printing, sign and send
applicable fees as required.Note:
Selecting "Reset" will clear all data
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Read the instructions before completing this form.
The following information pertains to a certificate of Assumed
Name that was filed with the Office of the Secretary of State on the
date listed in item #2. This certificate will expire if this renewal form
is not completed and returned to our office by the expiration date
listed in item #3. The filing fee for the Renewal is $25 which will
renew the registration for 10 years. Please remember that this
document must be signed by the current nameholder or an
authorized agent. Attach add'l sheets for nameholders if necessary.
Assumed Name #
CURRENT INFORMATION ON FILE:
INFORMATION YOU WISH TO CHANGE:
1. Assumed Name
Assumed Name
2. Date of Original Filing
3. Current Expiration Date
10 Year Extension
4. Business Address
Business address (must be a full street address)˜
Street:
Street:
State:
Zip:
City:
City:
State:
Zip:
5. Nameholder(s) and Address(es)
Nameholder(s) and Address(es) (If any changes are being
made to the nameholder(s) and/or their address(es), please
Name:
be sure to list ALL of the current nameholders and their full
street addresses in this box.)
Street:
Name:
City:
Street:
Zip:
State:
City:
Zip:
State:
I, the undersigned, certify that I am signing this document as the person whose signature is required, or as agent of the person(s)
whose signature would be required who has authorized me to sign this document on his/her behalf, or in both capacities. I further
certify that I have completed all required fields, and that the information in this document is true and correct and in compliance
with the applicable chapter of Minnesota Statutes. I understand that by signing this document I am subject to the penalties of
perjury as set forth in Section 609.48 as if I had signed this document under oath.
6. Signature ___________________________________________________________________ ____________________
(Signature of current nameholder or authorized agent)
Date
7. Name and telephone number of a contact person ___________________________________(____)________________
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AssumedNameRenewalRev.08-01-10
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