227 CERTIFICATE OF ASSUMED BUSINESS NAME Pursuant to Section 53-504, Idaho Code, the undersigned submits for filing a certificate of Assumed Business Name. Please type or print legibly. Instructions are included on back of application. 1. The assumed business name which the undersigned use(s) in the transaction of business is: 2. The true name(s) and business address(es) of the entity or individual(s) doing business under the assumed business name: Name Complete Address 3. The general type of business transacted under the assumed business name is: Retail Trade Wholesale Trade Services Transportation and Public Utilities Construction Agriculture Manufacturing Mining Finance, Insurance, and Real Estate 4. The name and address to which future correspondence should be addressed: Submit Certificate of Assumed Business Name and $25.00 fee to: Secretary of State 450 North 4th Street PO Box 83720 Boise ID 83720-0080 208 334-2301 5. Name and address for this acknowledgment copy is (if other than # 4 above): Secretary of State use only Signature: Printed Name: Capacity/Title: Signature: Printed Name: Capacity/Title: abn.pmd Rev. 07/2010 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS Optional: If the document requires a correction, please list a telephone number where we can reach you. Filing a Certificate of Assumed Business Name does not give a business any specific right to the use of the name on the Certificate. Before filing, it might prove useful to have the Secretary of State’s Office search the records for names which are identical or deceptively similar. Another business might already be using the name you wish to file; in many cases this would be a reason to select another name. Please be aware that all filings with this office are public record and are available upon request and via the internet. When an Assumed Business Name filing is required: (1) Any person who proposes to or intends to transact business in Idaho under an assumed business name shall, before beginning to transact business, file with the Secretary of State a certificate of assumed business name. (2) An entity which is organized, registered or admitted to the state by filing its organizational document or qualification papers with the Secretary of State is not required to file a Certificate of Assumed Business Name, except when it conducts business under a name other than its true name which appears on its organizational document or qualification papers. Formally organized or registered entities include corporations, limited liability companies, limited partnerships and limited liability partnerships. (3) If an individual is using both his/her legal first and last name within the business name, filing of this certificate is not required. One certificate must be filed per assumed business name. If an individual or business conducts business under more than one assumed name, it must file a separate certificate for each assumed business name it uses. Line 1. Enter the assumed business name exactly as is used in conducting the business with the public. Please note that the business name shall not include words or abbreviations which falsely imply the existence of a formally organized or registered entity, such as "Inc.", "corporation", "LLC" etc. Line 2. Enter the name and address of each individual who has a financial interest. (Since this information is public record we advise you use a business address and NOT a home address.) For a formally organized entity, enter in item #2 the true name exactly as it appears on the organizational or registration document, and its principal business address. Line 3. Check one or more boxes in item # 3. You MUST select one of the options that best describe your business. Do not make up your own category. Line 4. Enter the address to which the Secretary of State should send future correspondence concerning this certificate. Line 5. Acknowledgment address. If you want this certificate returned to a different address than listed on line 4, enter that address in line 5. Signature. The certificate must be signed by an individual who has actual authority to bind the business to legal obligations. The signer must be identified by printing or typing his/her name below the signature and indicate in what capacity they sign (i.e. president, partner, manager, owner, etc.) Only one signature is required, but space has been provided for more than one signature. Pursuant to Idaho Code § 67-910(6), the Secretary of State’s Office may delete a business entity filing from our database if payment for the filing is not completed. Mail or deliver to: Office of the Secretary of State 450 N 4th Street PO Box 83720 Boise ID 83720-0080 The filing fee is $25.00. If you have questions or need help, call the Secretary of State's office at (208) 334-2301. American LegalNet, Inc. www.FormsWorkFlow.com