Statement Of Change Of Trade Name Information Changing The Form Of Entity
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1
2Form must be filed electronically.
Paper forms are not accepted.
This copy is a sample and cannot be submitted for filing.
Statement of Change of Trade Name Information
Changing the Form of Entity
filed pursuant to § 7-90-305.5 of the Colorado Revised Statutes (C.R.S.)
1. The trade name ID number, the name of the person transacting business or conducting activities under the
trade name, and the trade name as stated in the statement of trade name are
Trade Name ID number
__________________________
(Colorado Secretary of State ID number)
Name
______________________________________________________
Trade name
______________________________________________________.
2. The document number of the filed document that is changed is ____________________________________.
3. The form of entity has changed.
4. Such form, as changed, is
_____________________________________________________.
5.
(If applicable, adopt the following statement by marking the box and include an attachment.)
This document contains additional information as provided by law.
6.
(Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has significant
legal consequences. Read instructions before entering a date.)
(If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required format.)
The delayed effective date and, if applicable, time of this document are ___________________________.
(mm/dd/yyyy hour:minute am/pm)
Notice:
Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that such document is
such individual's act and deed, or that such individual in good faith believes such document is the act and deed
of the person on whose behalf such individual is causing such document to be delivered for filing, taken in
conformity with the requirements of part 3 of article 90 of title 7, C.R.S. and, if applicable, the constituent
documents and the organic statutes, and that such individual in good faith believes the facts stated in such
document are true and such document complies with the requirements of that Part, the constituent documents,
and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the Secretary of
State, whether or not such individual is identified in this document as one who has caused it to be delivered.
7. The true name and mailing address of the individual causing this document to be delivered for filing are
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
______________________________________________________
(Street number and name or Post Office Box information)
______________________________________________________
CHANGE_TDNM_FORM
Page 1 of 2
Rev. 1/01/2008
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