Fictitious Name Certificate - Individual

Certificate of Transaction of Business
Under Fictitious Name - by Individual

Certificate

KNOW ALL MEN BY THESE PRESENTS:

That the undersigned does hereby certify the following:

1. The undersigned is transacting or proposes to transact
business in the State of _____________ under the
fictitious name of ______________________________________.

2. The principal place of said business is located at
______________________________________.

3. The full name of the undersigned is _________________.

4. The place of residence of the undersigned is _________
_______________________________________.

Dated _______________ ________________________
(Signature)