Amendment To Certificate Of Assumed Name Form - 2010 Page 2
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1
2INSTRUCTIONS
Retain the original signed copy of this document for your records and submit a legible photocopy for filing with the
Secretary of State.
State law requires that this Certificate of Assumed Name be filed and published prior to the conduct of any business.
Licensing and regulatory boards as well as private vendors and banks often require proof of the filing of this Certificate before
issuing licenses, permits or entering into business relationships with the business.
If any of the information on the most recently filed Certificate or Amended Certificate of Assumed Name changes, you must
file this Amended Certificate within 60 days.
1) State the exact business name (new name if changing name) on line 1. Only one business name may be filed per form.
Assumed names that duplicate corporate, limited partnership, limited liability partnership, limited liability company names or
trademarks already on file cannot be accepted for filing. Call the Business Information Line of the Office of the Secretary of
State at (651)296-2803 for a preliminary determination whether the assumed name can be filed. This will reduce the
possibility of rejection of the Certificate and will provide for faster filing of this Certificate. You may only use corporate or other
business entity designations if the business owner is a corporation or other business entity already entitled to use that
designation.
2) State a complete street address or rural route and rural route box number of the principal place of business in Minnesota.
A post office box cannot be accepted as the address of the principal place of business. If you have no business address in
Minnesota, please state that on the application in item 2 and list the out-of-state address.
3) List the name and complete street address of all persons conducting business under the assumed name. If the business
owner is a business organization such as a corporation, limited liability company, or limited partnership doing business under
an assumed name, the legal name and registered office address is required.
4) List the original Certificate of Assumed Name number, the date on which the original was filed and, if you are changing the
name in item 1, the original name. Refer to your original assumed name for this information.
5) A signature of one person listed in #3 or an Authorized Agent (The signing party must indicate on the document that they
are acting as the agent of the person(s) whose signature would be required and that they have been authorized to sign on
behalf of that person(s).), the date, printed name of the person signing, and the title of the signer. Also, please print the name
and daytime phone number of the person this office should contact if there are any questions about this form.
6) Filing Fee: $25.00 Payable to the MN Secretary of State.
FILE IN-PERSON OR MAIL TO:
Minnesota Secretary of State - Business Services
Retirement Systems of Minnesota Building
60 Empire Drive, Suite 100
St Paul, MN 55103
(Staffed 8:00 - 4:00, Monday - Friday, excluding holidays)
To obtain a copy of a form you can go to our web site at
, or contact us between 9:00am to 4:00pm,
Monday through Friday at (651) 296-2803 or toll free 1-877-551-6767.
7) The Certificate of Amended Assumed Name must be published after filing for two consecutive issues in the legal notices
section of a qualified legal newspaper in the county where the principal place of business is located. The newspaper will
return an affidavit of publication a copy of the published notice which should be kept by the assumed name holder with the
Certificate of Assumed Name. Failure to publish may render the Certificate of Amended Assumed Name Invalid.
8) Any changes due to a change of business name, address, ownership, or owner’s address, require the filing of a Certificate
of Amended Assumed Name form. The Certificate of Amended Assumed Name form must be filed within 60 days after any
change has occurred and must be published as described in paragraph 7 above.
All of the information on this form is public. Minnesota law requires certain information to be provided for this type of filing. If
that information is not included, your document may be returned unfiled. This document can be made available in alternative
formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing)
communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803. The
Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin,
age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the
provision of service.
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