Statement Of Trade Name Of An Individual
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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 Trade Name of an Individual
filed pursuant to §7-71-103 of the Colorado Revised Statutes (C.R.S)
1. The true name of the individual delivering this statement is
______________________ ________________ ______________ _______.
(Last)
(First)
(Middle)
(Suffix)
2. The principal address of such individual is
Street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
Mailing address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________.
(Province – if applicable)
(Country – if not US)
3.
The trade name under which such individual transacts business or contemplates transacting business in this
state is
_____________________________________________________________________________________.
4. A brief description of the kind of business transacted or contemplated to be transacted in this state under
such trade name is
_____________________________________________________________________________________.
5.
(If the following statement applies, adopt the 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
TRDNM_IND
Page 1 of 2
Rev. 1/01/2008
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