CERTIFICATE OF ASSUMED BUSINESS NAME
DELAWARE COUNTY, INDIANA
NAME OF BUSINESS:
______________________________________________
NATURE OF BUSINESS:
____________________________________________
ADDRESS OF BUSINESS:
___________________________________________
DATE ESTABLISHED:
______________________________________________
Form Prepared by:
_______________________________________
I affirm, under the penalties for perjury, that I have taken reasonable care to redact each Social
Security number in this document unless required by law.
Name:
___________________________________
SECTION TO BE COMPLETED IN PRESENCE OF NOTARY PUBLIC
_________________________
Signature of Owner
_________________________
Printed Name of Owner
_________________________
Address of Owner
Subscribed and sworn to before me, this _____ day of ____________, 20___.
_________________________
Signature of Notary
_________________________
County of Residence
_________________________
Commission Expiration Date
_________________________
Printed Name of Notary