Fillable Form F0073 - Fictitious Business Name Assignment

Form F0073 - Fictitious Business Name Assignment - 2010

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FOR OFFICE USE ONLY

Mississippi Secretary of State

11 F0073

P. O. Box 136, Jackson, MS 39205-0136

Fictitious Business Name Assignment

Miss Code Ann. §75-93-1 et seq.

The name to be assigned is:_______________________________________________________________

Assignor Name:_________________________________________________________________________

Assignee Name: _________________________________________________________________________

Address: ____________________________________________________________________________

City, State, ZIP 5, ZIP 4________________________________, _________________, ______________

Assignee MS business ID number (if any): ______________Business email: _________________________

State of Organization

The assignee is a foreign entity:

Yes; certificate of authority is attached with this application

Non-Mississippi businesses must indicate name of state or nation of organization and attach a copy of the businesses certificate to transact business in

Mississippi.

Street address(es) of business using name:

NAICS code/nature of business: ______________________

Any right, title, and interest in and to said fictitious business name together with the good will of business in

which the name is used (or that part of the good will of the business connected with the use of the name) is here

by assigned by to:

(the Assignee)

By:

(the Assignor)

Signed this ________ day of ______________, 20______.

_______________________________________

Assignor Signature