Amendment To Certificate Of Assumed Name Form - 2010
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1
2For your convenience, this form has been
designed to be completed online. You
MINNESOTA SECRETARY OF STATE
must have Acrobat Reader 7.0 or above to
use this new feature. Once your form is
completed, be sure to select "Print" at the
bottom of the screen to capture your data
AMENDMENT TO
entry for printing. After printing, sign and
send applicable fees as required.Note:
CERTIFICATE OF ASSUMED NAME
Selecting "Reset" will clear all data entry
Minnesota Statutes Chapter 333
from this page. To print a blank form, go to
File->Print.
Read the instructions before completing this form.
Filing Fee: $25.00
The filing of an assumed name does not provide a user with exclusive rights to that name. The filing is required for consumer
protection in order to enable consumers to be able to identify the true owner of a business.
1. State the exact assumed name under which the business is or will be conducted: (one business name per application)
___________________________________________________________________________________________________
2. State the address of the principal place of business.
___________________________________________________________________________________________________
Street
City
State
Zip code
(A complete street address or rural route and rural route box number is required; the address cannot be a P.O. Box.)
3. List the name and complete street address of all persons conducting business under the above Assumed Name, OR if an
entity, provide the legal corporate, LLC, or Limited Partnership name and registered office address. Attach additional
sheet(s) if necessary.
Name
(please print)
Street
City
State
Zip
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
4. This certificate is an amendment of Certificate of Assumed name number ______________________originally filed on
________________________ under the name ______________________________________________________________
(List the previous name only if you are amending that name.)
5. I, the undersigned, certify that I am signing this document as the person whose signature is required, or as agent
of the person(s) whose signature would be required who has authorized me to sign this document on his/her behalf, or in
both capacities. I further certify that I have completed all required fields, and that the information in this document is true
and correct and in compliance with the applicable chapter of Minnesota Statutes. I understand that by signing this document
I am subject to the penalties of perjury as set forth in Section 609.48 as if I had signed this document under oath.
____________________________________________________________
Signature (ONLY one person listed in #3 or an authorized agent is required to sign)
_____________
________________________________________________________________
Date
Print Name and Title
____________________________________________________________
Contact Person
Daytime Phone Number
Reset
Print
AssumedNameAmendmentRev.08-01-10
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