TRADE NAME REGISTRATION OR FRANCHISE NAME DISCLOSURE SECRETARY OF STATE SFN 13401 (09-2015) For Office Use Only ID Number: WO Number: Filed: Expiration Date: By: 1. FILING FEE: $25.00 Five Year Registration SEE PAGES 2 AND 3 FOR FEE, FILING AND MAILING INSTRUCTIONS TYPE OR PRINT LEGIBLY Yes (complete 2A and 2B below) Trade Name Registration with ownership rights to the name (you own the name or can sell franchises) For reference, see North Dakota Century Code, Chapter 47-25. No (proceed to number 3) Disclosure Information (you purchased a franchise) 2. Is the name to be registered a franchise name licensed to a franchisee? (i.e. McDonalds, Subway, etc.) 2A. If "Yes" in number 2 above, indicate whether this filing is a Trade Name Registration with ownership rights to the name or Disclosure Information. 2B. If "Yes" in number 2 above, provide the name, address, and telephone number of the franchiser or other licensor of the franchise name. ADDRESS Street/Rural Route Post Office Box City State ZIP+4 Telephone Number Franchiser Name 3. Trade name to be registered or franchise name to be licensed to franchisee. See instructions for prohibited words. 4. Address(es) and telephone number(s) of the principal place(s) of business. If no address, use owner's address. COMPLETE ADDRESS ZIP+4 Street/Rural Route Post Office Box City State Telephone Number 5. Provide in detail, the nature of business transacted (REQUIRED). General purposes is not allowed. 6. Trade name is used and owned by/franchise name is licensed to: (check one) Individual Married Couple (both must sign) Corporation - Provide state of origin: Limited Liability Company - Provide state of origin: Other - Define (see instructions): NOTE: This form does not establish the LLC or business corporation. It must already be registered with the Secretary of State. 7. Telephone Number of Owner or Franchisee 8. Toll Free Telephone Number 9. Name, federal ID number/social security number, and address of the owner(s) of the trade name or franchise name. If the owner is registered with the Secretary of State, the name must match EXACTLY as registered. COMPLETE MAILING ADDRESS OF PRINCIPAL PLACE OF BUSINESS Federal ID/Social Name Street/Rural Route Post Office Box City State ZIP+4 Security Number 10. "I (We), the owner(s) or franchisee(s), say that I (we) have read the foregoing registration, know the contents thereof, and believe the statements made to be true. I (We) authorize the Secretary of State to correct numbers 2, 6, or 9 if not correctly reflected." Signature Signature 11. Name of Person to Contact About This Document Email Address Date Date Daytime Telephone Number American LegalNet, Inc. www.FormsWorkFlow.com SFN 13401 (09-2015) Page 2 of 3 INSTRUCTIONS FOR TRADE NAME REGISTRATION / FRANCHISE NAME DISCLOSURE Any person, corporation, or limited liability company that engages in business in North Dakota under a trade name must register that trade name with the Secretary of State. The registration of the trade name is mandated by law and may be required in order to obtain certain licenses or permits, or to obtain certain privileges such as bank accounts in the trade name. A trade name is defined by law to be a name assumed to identify the business or activities of an individual or organization and which does not include in the name: 1. 2. 3. The true name of the organization using the name; The first name and surname of each individual using the business name; or The surname of each individual, repeating a surname if more than one owner has the same surname (i.e. a business owned by three Johnson brothers would need to be identified as Johnson, Johnson & Johnson ___________). A name assumed under subparagraph 3, or a name of an organization or association not otherwise registered with the Secretary of State, requires registration as a trade name if a license or permit to conduct business or operations is required by the State of North Dakota. The trade name registration provides protection of the name in North Dakota. A trade name filed with the Secretary of State prevents the filing of a trademark or another name that is the same as or deceptively similar by any corporation, limited liability company, any other trade name, fictitious partnership name, limited liability partnership, limited liability limited partnership or limited partnership. In the event that a name is used, which is deemed to be the same as or deceptively similar to a trade name that is registered, the registrant of such trade name may institute a civil suit prohibiting the further use of the name. (See North Dakota Century Code, Section 47-25-01.) If the trade name submitted for registration is the same as, or similar to a name already registered, the owner of the proposed trade name must obtain a "consent to use of name" from the previously registered entity. The consent to use of name authorization must be filed with the Secretary of State, along with $10, before the submitted trade name registration form can be filed. The registration of the trade name with the Secretary of State provides protection of the trade name in North Dakota. However; if a mark is registered with the Patent and Trademark Office in Washington, D.C., the federal registration may supersede the protection afforded by state law. Franchise Name Disclosure Information: An individual or organization that is a franchisee may not file a Trade Name Registration unless the franchisee has acquired ownership rights to the name. A franchisee must use this form to file disclosure information with the Secretary of State before using the franchise name in the State of North Dakota. The filing of the disclosure information does not extend any trade name protection provided by N.D.C.C., chapter 47-25. The following numbers correspond to the numbered sections on the front of this form. 1. 2. The registration fee is $25.00 and the registration period is five years. Checks must be payable to "Secretary of State" and must be for U.S. negotiable funds. Payment may also be made by credit card using VISA, Master Card, or Discover. Check the appropriate box indicating whether the name to be registered is a franchise name licensed to a franchisee. If the name is a franchise name licensed to a franchisee, provide the complete address and phone number of the franchiser, and indicate whether the franchisee acquired ownership rights to the name and is filing a Trade Name Registration or if this filing is Disclosure