Assumed Name Certificate For Incorporated Business Form

ASSUMED NAME CERTIFICATE

FOR IN CORPORA TED BUSINESS

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THAT

, the undersigned, for the purpose of complying with

Chapter 36, Title 4, Business and Commerce Code of the State of Texas, do hereby certify to the following facts:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ is the assumed name under which

the business or professional service is or is to be conducted or rendered.

physical address (including

City, State & Zip Code) of the assumed name business or professional service.

Registrant (Corporation/Company Name) _________________________ _

Name and addresses of officers:

Name. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Address

--------------------------------------------------------------------

Title

-----------------------------------------------------------------------

Name

-----------------------------------------------------------------------

Address

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Title

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Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Address __________________________________________________________________ ___

Title _____________________________________________________________________ _

Said Registrant was duly incorporated/associated under the laws of the State of Texas and its registered or similar office

address is: ________________________________________ _

County or Counties within the State of Texas where the business or professional services are being or are to be

conducted or rendered under said assumed name ___________________________

Signed: ________________________________________ _

STATE OF TEXAS

COUNTY OF _ _ _ _ _ _ _ __

Before me, the undersigned authority, on this _ _ day of ___________ 20 _ _ personally appeared

--~~~--~----------------------of

_____________

~-----------------------------

Authorized Officer Name

Corporation/Company Name

Known to me to be the person whose name is subscribed to the foregoing instrument and acknowledge to me that

he/she executed the same for the purpose and consideration therein expressed in the capacity therein state and as the act

of deed of said corporation/company.

Given under my hand and Seal on this the

day of

, 20 _ _

My Commission expires:

Notary Public, State of Texas

Notary's printed name:

(Seal)

Assumed Name Certificate For Incorporated Business Form - Texas

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