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]