Form F0071 - Fictitious Business Name Amendment
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1Mississippi Secretary of State
11 F0071
P.O. Box 136, Jackson, MS 39205-0136
FOR OFFICE USE ONLY
Fictitious Business Name Amendment
Miss. Code Ann. § 25-93-1 et seq.
(
:___________________________________
Legal Name
corporate , LLC, partnership, individual etc.)
Address: _____________________________________________________________________________________
MS business ID number (if any): _______________________Business email: ______________________________
Current Registered Business Name: _____________________________________________________________
Street address(es) of business using name:
Amended Business Name:
___________________________________________________________________________
NAICS Code / Nature of Business: ____________________
The Applicant, through its undersigned authorized representative, is familiar with the provisions of Mississippi Code Annotated §25-
93-1 et seq. and understands that filing this form creates no exclusive rights in or to the fictitious/Business name which is the subject
of this application. Signed this _______ day of __________________, 20_______.
_______________________________________
____________________________________________
Signature
Printed Name
____________________________________________
Title
Make Check for $25.00 payable to SECRETARY OF STATE. Mail completed form with payment to SECRETARY OF STATE, PO
BOX 136, JACKSON, MS 39205-0136. For assistance contact a customer service representative at (800) 256-3494. Visit our website
at
for forms and instructions.
F0071 7/1/2010
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