Certificate Doing Form

Certificate of Doing Business Under Assumed Name D/B/A Ulster County Clerk s Office 244 Fair Street Kingston NY 12401 845 -340-3288 Nina Postupack Ulster County Clerk www. co. ulster. ny. us. gov PURSUANT TO SECTION 130 OF THE GENERAL BUSINESS LAW OF NEW YORK STATE 1. I certify that my name is print name 2. I live at 3. I intend to do business in ULSTER COUNTY at the following address in city town village New York zip 4. I will do business under the name 5. I further certify that I am the successor in interest to the following person who formerly used this name or names to conduct transact business person s name My Signature Date Print or type name under signature If under 21 years of age state I am years of age STATE OF NEW YORK COUNTY OF SS On this day of 20 before me the undersigned personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity and that by his/her signature on the instrument the individual or the person upon behalf of the which the individual acted executed the instrument. Signature of individual taking acknowledgment Notary Public Instructions Use this form for a DBA by an INDIVIDUAL* Complete the form BUT DO NOT SIGN IT until you are in the presence of a Notary Public* My staff are Notaries and can witness your signature at no charge if you wish. Bring the form to the Ulster County Clerk s Office at 244 Fair St* in Kingston together with 25. 00 cash or money order payable to Ulster County Clerk s Office. A certified copy may be obtained at the cost of 5. 00 per copy. Our office hours are 9 00AM to 4 45PM Monday through Friday except holidays. There are other forms for Partnerships filing DBA s as well as amendment and termination forms. The Partnership form is available in our office for a fee of 1. co. ulster. ny. us. gov PURSUANT TO SECTION 130 OF THE GENERAL BUSINESS LAW OF NEW YORK STATE 1. I certify that my name is print name 2. I live at 3. I intend to do business in ULSTER COUNTY at the following address in city town village New York zip 4. I live at 3. I intend to do business in ULSTER COUNTY at the following address in city town village New York zip 4. I will do business under the name 5. I further certify that I am the successor in interest to the following person who formerly used this name or names to conduct transact business person s name My Signature Date Print or type name under signature If under 21 years of age state I am years of age STATE OF NEW YORK COUNTY OF SS On this day of 20 before me the undersigned personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity and that by his/her signature on the instrument the individual or the person upon behalf of the which the individual acted executed the instrument.