Business Name Registration / Dba Application Form

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Instructions
This form must be type written or computer generated.
State of Utah
Department of Commerce
Clear Form
Division of Corporations & Commercial Code
Print Form
Business Name Registration / DBA Application
WARNING:
The filing of this application and its approval by the Division does not authorize the use in the state of Utah of an assumed
name in violation of the rights of another under federal, state, or common law (U.C.A. Section 42-2-5 Et seq.).
*When approved the DBA is registered for 3 years.
*If
adding or removing
an Applicant/Owner, which will affect its status as a General Partnership or Sole Proprietorship, you must submit a
Registration Information Change Form.
Link to DBA Transfer form
*If you want a
new name
(adding or changing the existing name), a new DBA filing is required.
Non-Refundable Processing Fee: [
] New Filing $22.00
[
] Applicant/Owner Transfer N/A
Requested Business Name:
Business Purpose:
Business Address:
______________________________________________________________________
Address
City
State
Zip
Who/What is the name of the Registered Agent (Individual or Business Entity or Commercial Registered Agent)?:
________________________________________________________________________________________
What is a commercial registered agent?
The address must be listed if you have a non-commercial registered agent. See instructions for further details.
___________________________________________________________
Address of the Registered Agent:
Utah Street Address Required, PO Boxes can be listed after the Street Address
City:
State UT
Zip:
Applicant/Owner:
Name: _______________________________________________________________________________
List the individual or business
Entity Number (if a registered business): ____________________________________________________
entity that will own the DBA on
the name line.
Address: _____________________________________________________________________________
City: __________________________________________________ State: ________ Zip: ____________
(The registered agent will be
recorded as the applicant/owner if
Under penalties of perjury, I declare that this DBA Application has been examined by me and is, to the best of my
this section is left blank)
knowledge and belief, true, correct and complete
.
Sign here after the form is printed
Signature:
Applicant/Owner:
Name: _______________________________________________________________________________
List the individual or business
Entity Number (if a registered business): ____________________________________________________
entity that will own the DBA on
the name line.
Address: _____________________________________________________________________________
City: __________________________________________________ State: ________ Zip: ____________
If needed, you may use an
Under penalties of perjury, I declare that this DBA Application has been examined by me and is, to the best of my
attached sheet for additional
knowledge and belief, true, correct and complet
e.
applicants
Sign here after the form is printed
Signature:
Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the
business entity physical address rather than the residential or private address of any individual affiliated with the entity.
Optional Inclusion of Ownership Information: This information is not required.
Is this a female owned business?
Yes
No
Select/Type the race of the owner here
Is this a minority owned business?
Yes
No
If yes, please specify:
Division's Website:
Mailing/Faxing Information:
01/14

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