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Assumed Business Name - Amendment Form. This is a Oregon form and can be use in Business Registry Secretary Of State.
Tags: Assumed Business Name - Amendment, 02, Oregon Secretary Of State, Business Registry
Assumed Business Name - AmendmentSecretary of State - Corporation Division - 255 Capitol St. NE, Suite 151 - Salem, OR 97310-1327 - sos.oregon.gov/business - Phone: (503) 986-2200 In accordance with Oregon Revised Statute 192.410-192.490, the information on this application is public record.We must release this information to all parties upon request and it will be posted on our website.For office use only REGISTRY NUMBER:Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary.1. CURRENT BUSINESS NAME:3. DESCRIPTION OF BUSINESS:5. PRINCIPAL PLACE OF BUSINESS: (Street Address, City, State, Zip)4. NAME OF AUTHORIZED REPRESENTATIVE: (One name only) MAILING ADDRESS OF AUTHORIZED REPRESENTATIVE: 10.SIGNATURE(S): New Registrants must sign.240 If any Registrants are WITHDRAWING, withdrawing Registrants or Authorized Representative must sign. Signature: Printed Name: CONTACT NAME: (To resolve questions with this filing) PHONE NUMBER: (Include area code)FEESIf Changing Business Name $50 No Fee For Other Changes Processing Fees are nonrefundable. Please make check payable to "Corporation Division".Free copies are available at sos.oregon.gov/business using the Business Name Search program. Assumed Business Name - Amendment (11/17) 6.9.COUNTIES: ALL COUNTIES (Statewide) Baker Benton Clackamas Clatsop Columbia Coos Crook Curry Deschutes Douglas Gilliam Grant Harney Hood River Jackson Jefferson Josephine Klamath Lake Lane Lincoln Linn Malheur Marion Morrow Multnomah Polk Sherman Tillamook Umatilla Union Wallowa Wasco Washington Wheeler Yamhill NEW BUSINESS NAME: (If changed, $50 fee required)2. CONTINUING or NEW Complete only the sections that you are updating. To review current information, please go to: sos.oregon.gov/bizsearchFax: (503) 378-4381 Registrant Name Street Address City State ZipCURRENT REGISTRANTS/OWNERS ADDRESS CHANGE ONLY: (This section is only for registrant address changes)(Attach separate sheet if needed)8. b.WITHDRAWING REGISTRANTS/OWNERS:REGISTRANTS/OWNERS: (List name and publicly available street address of new registrants)(Attach separate sheet if needed)7. a.NEW REGISTRANTS/OWNERS:Street AddressCityStateZipI declare as an authorized signer, under penalty of perjury, that this document does not fraudulently conceal, obscure, alter, or otherwise misrepresent the identity of any person including officers, directors, employees, members, managers or agents.240 This filing has been examined by me and is, to the best of my knowledge and belief, true, correct and complete.240 Making false statements in this document is against the law and may be penalized by fines, imprisonment, or both. American LegalNet, Inc. www.FormsWorkFlow.com