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Unformatted text preview: ce company, etc. 4. The file number, if any, issued to the entity by the secretary of state is:
5. The state, country, or other jurisdiction of formation of the entity is:
6. The entity’s principal office address is:
Street or Mailing Address
City State Country Postal or Zip Code Period of Duration
7a. The period during which the assumed name will be used is 10 years from the date of filing
with the secretary of state.
OR 7b. The period during which the assumed name will be used is
with the secretary of state (not to exceed 10 years). years from the date of filing OR 7c. The assumed name will be used until (not to exceed 10 years).
mm/dd/yyyy Form 503 4 County or Counties in which Assumed Name Used
8. The county or counties where business or professional services are being or are to be conducted or
rendered under the assumed name are:
All counties with the exception of the following counties: Only the following counties: Execution
The undersigned signs this document subject to the penalties imposed by law for the submission of a
materially false or fraudulent instrument and also certifies that the person is authorized to sign on
behalf of the identified entity. If the undersigned is acting in the capacity of an attorney in fact for the
entity, the undersigned certifies that the entity has duly authorized the undersigned in writing to
execute this document.
Date: Signature of a person authorized by law to sign on behalf of the
identified entity (see instructions) Print Form 503 5 Reset...
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- Spring '14