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Assumed Name Record Certified Of Ownership For Unincorporated Business Or Profession (Or Incorporated) Form - State Of Texas County Of Palo Pinto

ASSUMED NAME RECORD

CERTIFIED OF OWNERSHIP FOR UNINCORPORATED BUSINESS OR PROFESSION

(OR INCORPORATED)

NOTICE: Certificates of ownership are valid for a period not to exceed 10 years from the date filed in the County

Clerk’s Office. (Chapter 36, Sec 1, Title 4, Business and Commerce Code)

Business Name:____________________________________________________________________

Business Address:____________________________________Phone #_______________________

City:_______________________________ State:___________________ Zip Code:____________

Assumed Names are valid for a period of 10 years

_____Proprietorship

_____Sole Proprietorship

______Joint Venture

_____General Partnership

_____Other (Name Type)_____________________________

CERTIFICATE OF OWNERSHIP

I/We, the undersigned, are the owner of the above business and address given is/are true and correct, and there is/are

no ownership(s) in said business other than those listed above.

Name:_______________________________ Signature:____________________________________

(Print)

Address:____________________________________________________Zip Code:______________

(Residence)

Name:_______________________________ Signature:____________________________________

(Print)

Address:____________________________________________________Zip Code:______________

(Residence)

Name:_______________________________ Signature:____________________________________

(Print)

Address:____________________________________________________Zip Code:______________

(Residence)

Name:_______________________________ Signature:____________________________________

(Print)

Address:____________________________________________________Zip Code:______________

(Residence)

STATE OF TEXAS

COUNTY OF PALO PINTO

Before me, the undersigned authority, on this day personally appeared______________________________________

known to me to the person(s) whose name(s) are subscribed to the foregoing instrument and acknowledged to me that

he/she signed thte same for the purpose and consideration therein expressed.

GIVEN UNDER MY HAND AND SEAL OF OFFICE THE _______ DAY OF _____________________., 20_____.

________________________________________________

Texas Comptroller ‘s Office

Notary Public in and for the State of Texas

2108 E Randol Mills Rd., #100

Arlington, TX 76011

________________________________________________

817/459-1155

Janette K. Green, County Clerk, Palo Pinto County

________________________________________________

By: Deputy County Clerk

Assumed Name Record Certified Of Ownership For Unincorporated Business Or Profession (Or Incorporated) Form - State Of Texas County Of Palo Pinto

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