Assumed Name (Dba) Certificate Of Ownership For Unincorporated Business Or Profession Form printable pdf download

ASSUMED NAME (DBA) CERTIFICATE OF OWNERSHIP

FOR UNINCORPORATED BUSINESS OR PROFESSION

NOTICE: “Assumed Names/DBA” are valid only for a period not to exceed 10 years from the date filed in the County Clerk’s Office. THE COUNTY

CLERK IS NOT RESPONSIBLE FOR VERIFYING THE ACCURACY OF THE INFORMATION CONTAINED IN AN “ASSUMED NAME/DBA” CERTIFICATE.

ONCE FILED WITH THE COUNTY CLERK, THIS DOCUMENT BECOMES A PERMANENT RECORD AND MAY BE CHANGED OR AMENDED ONLY BY

FILING A NEW CERTIFICATE. THE COUNTY CLERK MAY REFUSE TO RECORD A CERTIFICATE THAT IS CLEARLY DEFECTIVE ON ITS FACE. CHAPTER

71, TEXAS BUSINESS & COMMERCE CODE.

: _______________________________________________________________________________

BUSINESS NAME

: ______________________________________________________________________

PHYSICAL BUSINESS ADDRESS

___________________________________

___________________

: ____________________

CITY:

STATE:

ZIP CODE

): _______________________________

PHONE (optional

THE PERIOD, NOT TO EXCEED 10 YEARS, DURING WHICH THE ASSUMED NAME WILL BE USED (I.E., “10 years”): ____________________

BUSINESS IS TO BE CONDUCTED AS (check One):

 Sole Proprietorship

 Sole Practitioner

 General Partnership

 Joint Venture

 Other (Specify) ____________________________________________________________

CERTIFICATE OF OWNERSHIP

I/We, the undersigned, are the owner(s) of the above named business and my/our name(s) and address(es) given is/are true and correct, and there

is/are no ownership(s) in said business other than those listed herein below. By signing below, the applicant(s) acknowledge understanding of and

compliance with the statutes cited below.

- OWNER(S) INFORMATION and SIGNATURE(S) -

Name: _____________________________________________

Signature: __________________________________________________

Residence Address: ___________________________________

City, State, Zip: _______________________________________

Printed Name/Title:__________________________________________

Name: _____________________________________________

Signature: __________________________________________________

Residence Address: ___________________________________

City, State, Zip: _______________________________________

Printed Name/Title:__________________________________________

Name: _____________________________________________

Signature: __________________________________________________

Residence Address: ___________________________________

City, State, Zip: _______________________________________

Printed Name/Title:__________________________________________

WARNING: INTENTIONALLY PROVIDING FALSE OR FRAUDULENT INFORMATION ON THIS APPLICATION IS A VIOLATION OF THE LAW AND MAY

RESULT IN IMPRISONMENT OF NOT MORE THAN 5 YEARS AND/OR FINE OF UP TO $ 10,000. (Texas Business and Commerce Code, Chapter 71, Sec.

71.203; Texas Penal Code, Chapter 12 and Chapter 37, Sec. 37.10)

THE STATE OF ______________________

COUNTY OF ________________________

Before me on this day personally appeared ___________________________________________________________________________

___________________________________________________________________________________________________________, known to me

or proved to me through ___________________________________ to be the person(s) whose name(s) is/are subscribed to the foregoing

instrument and acknowledged to me that he/she/they executed the same for the purposes and consideration therein expressed

GIVEN UNDER MY HAND AND SEAL OF OFFICE, ON __________________________________________________, 20 ___________.

______________________________________________

Notary Public/Printed Name

SPACE BELOW RESERVED FOR RECORDING PURPOSES ONLY

Assumed Name (Dba) Certificate Of Ownership For Unincorporated Business Or Profession Form

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