Form Bus41 - Certificate Of Assumed Name Renewal (2003)
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MINNESOTA SECRETARY OF STATE
page. To print a blank form, go to File->Print.
CERTIFICATE OF ASSUMED NAME RENEWAL
Read the directions on the back before completing. 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
Renewal is $25
listed in item #3. The filing fee for the
which will
renew the registration for 10 years. Please remember that this
document must be signed by the current nameholder.
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:
State:
Zip:
City:
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:
Attach additional sheets if necessary
Attach additional sheets if necessary
I certify that I am authorized to execute this renewal and I further certify that I understand that by signing it 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 of current Nameholder _____________________________________________________ ____________________
(Most current nameholder must sign)
Date
7. Name and telephone number of a contact person ______________________________________
(____)________________
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bus41 Rev. 3-03
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