BUSINESS CERTIFICATE FOR PARTNERS Dutchess County Clerk's Office, 22 Market Street, Poughkeepsie, NY 12601 Bradford H. Kendall, Dutchess County Clerk (845-486-2120) 1. We certify that our full names and addresses are (print name and address and age of any who may be under eighteen): __________________________ ___________________________________________________ __________________________ ___________________________________________________ __________________________ ___________________________________________________ __________________________ ___________________________________________________ 2. We intend to do business in DUTCHESS COUNTY at the following address: _____________ ______________________, in (city/town)_________________________, NY (zip)___________ 3. We will do business under the name _______________________________________________ ______________________________________________________________________________ 4. We further certify that we are the successors in interest to _____________________________ ______________________________________________________________________________ (the person or persons who formerly used this name to conduct or transact business). Our signatures:_________________________ _____________________________________ _____________________________________ STATE OF NEW YORK } COUNTY OF DUTCHESS } SS: On this _______day of_____________________, 20___, before me, the undersigned, personally appeared ______________________________________________________________________________________ _____________________________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity and that by his/her signatures on the instrument the individual, or the person upon behalf of which the individual acted executed the instrument. ____________________________________________________________ (Signature and office of individual taking acknowledgment-Notary Public) ___________________________________ ___________________________________ ___________________________________ American LegalNet, Inc. www.FormsWorkFlow.com