Business Name Registration / Dba Application - Utah Department Of Commerce
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1Business Registration - Optional Inclusion of Ownership Data
This form must be type written or computer generated.
State of Utah
Instructions
DEPARTMENT OF COMMERCE
Clear Form
Division of Corporations & Commercial Code
Business Name Registration / DBA Application
Print Form
WARNING:
The filing of this application and its approval by the Division of Corporations and Commercial Code 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:
_____________________________________________________________________
City: _____________________________________ State: ___________ Zip: _______________
What is a commercial registered agent?
Is the registered agent a
commercial registered
agent?
YES
NO
If Yes, is the
commercial registered agent
an:
Individual
Entity
If an individual, what is the name of the individual (First, Middle, Last): __________________________________________
What is the Commercial Registered Agent Registration Number? (required): _
________________________________________
Registered Agent Name: __________________________________________________________________________________
I hereby accept appointment as Registered Agent for the above named business entity.
The Registered Agent must sign here after the form is printed
Signature of Registered Agent (Required): __________________________________________
__________________________________________________________
Address of the Registered Agent:
Utah Street Address Required, PO Boxes can be listed after the Street Address
City: ________________________________________________________________
State UT
Zip: _______________
Applicant/Owner:
(The registered agent will be recorded as the applicant/owner if this section is left blank)
List the individual or business
Name: ___________________________________________________________________________
entity that will own the DBA on
Entity Number (if a registered business): ________________________________________________
the name line.
Address: _________________________________________________________________________
City: ______________________________________________ State: ________ Zip: ____________
Under penalties of perjury, I declare that this DBA Application has been examined by me and is, to the best of my
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: ____________
Under penalties of perjury, I declare that this DBA Application has been examined by me and is, to the best of my
knowledge and belief, true, correct and complet
e.
Sign here after the form is printed
Signature:
IF NEEDED, YOU MAY USE AN ATTACHED SHEET FOR ADDITIONAL APPLICANTS
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.
Division's Website:
Mailing/Faxing Information:
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