Assumed Name Certificate For An Incorporated Business Or Profession Template
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1OFFICE OF JOHN F. WARREN
COUNTY CLERK, DALLAS COUNTY, TEXAS
ASSUMED NAME CERTIFICATE FOR AN INCORPORATED BUSINESS OR PROFESSION
NOTICE: “CERTIFICATES” ARE VALID NOT TO EXCEED 10 YEARS FROM THE DATE FILED IN THE
COUNTY CLERK’S OFFICE CHAPTER 71, SECT. 151(a), TITLE 5 BUSINESS AND COMMERCE CODE
THIS CERTIFICATE PROPERLY EXECUTED IS TO BE FILED IMMEDIATELY WITH THE COUNTY CLERK
NAME UNDER WHICH BUSINESS OR PROFESSIONAL SERVICES IS OR WILL BE CONDUCTED:
__________________________________________________________________________________________________
(Print or Type)
Address: ___________________________________________________________________________________________
City: ___________________________________________State:______________________Zip Code: ________________
1. The name of the incorporated business or profession as stated in its Articles of Incorporation or comparable document is:
__________________________________________________________________________________________________.
2. The state, country, or other jurisdiction under the laws of which it was incorporated is___________________________
_______________________________and the address of its registered or similar office in that jurisdiction is:
__________________________________________________________________________________________________.
3. The period, not to exceed ten years, during which this assumed name will be used is:____________________________
4. The corporation is a (circle one) business operation, non-profit corporation, professional corporation, professional association
or other type of corporation (specify) ___________________________________________________________________.
5. If the corporation is required to maintain a registered office in Texas, the address of the registered office is __________
__________________________________________________________________________________________________ and
the name of its registered agent at such address is_________________________________________________. The address of
the principal office (if not the same as the registered office) is: _______________________________________________
__________________________________________________________________________________________________.
6. If the corporation is not required to or does not maintain a registered office in Texas, the office address in Texas is: ____
__________________________________________________ and if the corporation is not incorporated, organized or associated
under the laws of Texas, the address its place of business in Texas is: ______________________________, and the office
address elsewhere is: __________________________________________________________________________________
7.The county or counties where business or professional services are being or are to be conducted or rendered under such
assumed name are (if applicable, use the designation “all” or “all except __________________________________________”).
8. If this instrument is executed by the attorney-in-fact, the attorney-in-fact hereby states that he has been duly authorized, in
writing, by his principal to execute and acknowledge this instrument.
________________________________________
Signature Corp. Officer, representative
or attorney-in-fact of the corporation
THE STATE OF TEXAS, COUNTY OF DALLAS
BEFORE ME, THE UNDERSIGNED AUTHORITY, on this day personally appeared _________________________________,
Known to me to be the person(s) whose name(s) is/are the subscribed to the foregoing instrument and, under oath, acknowledged
to me that (s) he signed the same for the purpose and consideration therein expressed.
GIVEN UNDER MY HAND AND SEAL OF OFFICE, on _____________________________,20__________
JOHN F. WARREN, COUNTY CLERK
DALLAS COUNTY, TEXAS
By_______________________________________, or
Deputy County Clerk
________________________________________
Notary Public in and for Dallas County
Form No 4243(Rev. 02-10)
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