Use black ink REGISTRATION OF FIRM NAMES STATE OF WISCONSIN, COUNTY OF __________________________ _____________________________________________, being first duly sworn deposes and says that he/she is _____________________________________ of the firm doing business under the name of: __________________________ _______________________________________________________________ and located at: ___________________________________________________ _____________________________________________ and that such firm is a (circle one) sole trader co-partnership association engaged Recording area Name and return address: in the business of __________________________________________________ and that the only persons interested financially in such business or using such name are the following: NAME RELATIONSHIP TO THE ADDRESS BUSINESS Application is hereby made to register such firm name with the Register of Deeds for the purpose of complying with the requirement of section 134.17 of the Wisconsin Statutes. ___________________________________________________ _________________________________________________ Signature Date Signature Date ___________________________________________________ _________________________________________________ Print name Print name This document was drafted by: STATE OF WISCONSI N, County of _____________________________________ (print or type name below) Subscribed and sworn to before me on______________________by the above named person(s). Signature of notary or other person authorized to administer an oath (as per s. 706.06, 706.07) *Names of persons signing in any ____________________________________________________ capacity must be typed or printed below their signature. WRDA 12/20/2001 Print or type name: ____________________________________________________ Title ____________________________ Date commission expires: _______________.