BUSINESS REGISTRATION CERTIFICATE PERSONS CONDUCTING BUSINESS UNDER ASSUMED NAME GENESEE COUNTY CLERK FILING FEE $10.00 THE UNDERSIGNED hereby certifies, under the provisions of P.A. No. 101, P.A. of MI, for the year 1907, as amended, that the following person (or persons) now owns, carries on, conducts or transacts, or intends to own, carry on, conduct, or transact, a business, or maintain an office or place of business, in the County of Genesee, State of Michigan, under the name, designation or style set forth below: Name of Business: _______________________________________________________________________________________________________________ Address of Business (Street, City, St, Zip): ____________________________________________________________________________________________ Post Office Boxes are not allowed Located in the (check one) City, Township, Village of: _____________________________________________________________________ The undersigned further certifies that the true or real full name and residential address (Post Office Boxes are not allowed) of the person(s) owning, conducting or transacting said business is: RESIDENTIAL ADDRESS NAME CITY STATE ZIP _________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________ SIGNATURES OF PERSONS CONDUCTING BUSINESS UNDER ASSUMED NAME ________________________________________________________________ ________________________________________________________________ STATE OF MICHIGAN COUNTY OF GENESEE A.D., 20 day of _______________________________ Subscribed and sworn to before me this by all the persons listed above. (Notary Public Signature) _____________________________________________________________________ Notary Public, Genesee County, Michigan. My Commission Expires: _____________________ (Printed Name) THIS CERTIFICATE EXPIRES FIVE YEARS FROM DATE OF FILING WITH COUNTY CLERK (Form below for use of County Clerk) File Date: STATE OF MICHIGAN COUNTY OF GENESEE Expiration Date: ___________________ I, Michael J. Carr, Clerk of the County of Genesee and the Circuit Court thereof, do hereby certify that I have compared the foregoing copy of Business Registration Certificate with the original of record in my office, and that the same is a correct transcript therefrom, and of the whole of such original. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said Circuit Court, at the City of Flint on this: MICHAEL J. CARR, GENESEE COUNTY CLERK By: _____________________________________________________ DEPUTY COUNTY CLERK Mail this application, notarized with the $10.00 fee to: Genesee County Clerk, Assumed Names, 900 S. Saginaw St, Flint, MI 48502. American LegalNet, Inc. www.USCourtForms.com