State Form 30353 - Pass-Through Entity Identification - 2013

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CERTIFICATE OF ASSUMED BUSINESS NAME
CONNIE LAWSON
(All Entities)
SECRETARY OF STATE
CORPORATIONS DIVISION
State Form 30353 (R15 / 7-13)
302 W. Washington Street, Room E018
Approved by State Board of Accounts, 2013
Indianapolis, Indiana 46204
Indiana Code 23-15-1-1
Telephone: (317) 232-6576
INSTRUCTIONS:
FILING FEES PER CERTIFICATE
1. Use an 8 1/2” x 11” sheet of white paper for attachments.
For-Profit Corporation, Limited Liability
2. Present original and one (1) copy to address in upper right corner of this form.
Company, Limited Partnership
$30.00
3. Please TYPE or PRINT.
4. Please visit our office on the web at
Not-For-Profit Corporation
$26.00
1. Name of entity
2. Date of incorporation / admission / organization (month, day, year)
3. Address at which the entity will do business under the assumed name (number and street)
City, state, and ZIP code
4. Assumed business name(s)
5. Principal office address of the entity (number and street)
City, state, and ZIP code
6. Signature of officer or other authorized party
7. Printed name and title
This instrument was prepared by:

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