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Unincorporated_Assumed_Name_Form

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					                                                                  JOHNSON COUNTY, TEXAS

                                                     ASSUMED NAME RECORDS
                                CERTIFICATE OF OWNERSHIP FOR UNINCORPORATED BUSINESS OR PROFESSION




                                             (NAME IN WHICH THE BUSINESS IS OR WILL BE CONDUCTED)

    BUSINESS ADDRESS: _____________________________________________________________________________________


CITY: _______________________________________STATE_____________________ZIP CODE___________________________


PERIOD (NOT TO EXCEED 10 YEARS) DURING WHICH ASSUMED NAME WILL BE USED: _______________________
                                  (CHAPTER 36.1 – BUSINESS AND COMMERCE CODE)

BUSINESS IS TO BE CONDUCTED AS (CHECK ONE): _____ SOLE PROPRIETORSHIP                                       ____ PRACTITIONER
_____ JOINT VENTURE                 _____ GENERAL PARTNERSHIP                       ______ LIMITED PARTNERSHIP
_____ REAL ESTATE INVESTMENT TRUST                             _____ JOINT STOCK COMPANY
_____ OTHER (NAME TYPE) ________________________________________

                                                               CERTIFICATE OF OWNERSHIP

I/WE, THE UNDERSIGNED, ARE THE OWNER__ OF THE ABOVE BUSINESS AND MY/OUR NAME___ AND ADDRESS___ GIVEN IS/ARE
TRUE AND CORRECT, AND THERE IS/ARE NO OWNERSHIP(S) IN SAID BUSINESS OTHER THAN THOSE LISTED HEREIN BELOW.

                                                                    NAMES OF OWNERSHIP


          NAME___________________________________________ SIGNATURE__________________________________________________


              ADDRESS____________________________________________ CITY, STATE, ZIP______________________________________


          NAME___________________________________________ SIGNATURE__________________________________________________


              ADDRESS_____________________________________________CITY, STATE, ZIP______________________________________


          NAME___________________________________________ SIGNATURE__________________________________________________


              ADDRESS______________________________________________CITY, STATE, ZIP_____________________________________


----------------------------------------------------------------------------------------------------------------------------------------------------------------------


THE STATE OF TEXAS
COUNTY OF_______________________


BEFORE ME ___________________________________________________ ON THIS DAY PERSONALLY APPEARED
                (NAME OF NOTARY)
___________________________________________________________KNOWN TO ME (OR PROVED TO ME ON THE OATH OF)
         (NAME(S) LISTED ABOVE)

____________________OR THROUGH ______________________ (DESCRIPTION OF IDENTITY CARD OR OTHER DOCUMENT) TO BE THE
PERSON WHOSE NAME IS SUBSCRIBED TO THE FOREGOING INSTRUMENT AND ACKNOWLEDGED TO ME THAT THEY EXECUTED THE
SAME FOR THE PURPOSE AND CONSIDERATION THEREIN EXPRESSED.


GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS ___________ DAY OF _________________________A.D. ___________




                                                                                                    NOTARY PUBLIC

				
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