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2. This is to certify that the below named person, partnership, limited liability company or corporation intends to conduct or transact business under an assumed or fictitious name in the:

   1. City

   1. County
3. City / County of
5. The assumed or fictitious name of business
7. The business is owned by the following entity type

   1. Sole Proprietorship
   2. Partnership

   1. Limited Liability Company
   2. Corporation
9. Name of owner
11. Residence Address
13. Address 2
15. City
16. State
17. Zip
19. Post Office Address
21. City
22. State
23. Zip
25. Name of Partnership
27. Office Address
29. Address 2
31. City
32. State
33. Zip
35. Post Office Address
37. City
38. State
39. Zip
41. Is this a general partnership?

    1. Yes

    1. No
43. Is this a domestic limited partnership?

    1. Yes

    1. No

    If yes, a certified copy of this certificate must be filed with the State Corporation Commission. Va. Code § 59.1-70.
45. Is this a foreign limited partnership?

    1. Yes

    1. No
47. If yes, indicate the date of the certificate of registration to transact business in the Commonwealth of Virginia issued by the State Corporation Commission
    A certified copy of this certificate must be filed with the State Corporation Commission. Va. Code § 59.1-70.
49. Name of corporation
51. Name of limited liability company
53. Office Address
55. Address 2
57. City
58. State
59. Zip
61. Post Office Address
63. City
64. State
65. Zip
67. A corporation or limited liability company must file a certified copy of this certificate with the State Corporation Commission. Va. Code § 59.1-70.
    
    Is this a foreign corporation or a foreign limited liability company?

    1. Yes

    1. No
69. If yes, indicate the date of the certificate of authority/registration to transact business in the Commonwealth of Virginia issued by the State Corporation Commission
71. Sole Proprietorship
    Name of Owner
73. Partnership
    Name of General Partner
75. Corporation
    Name of President
77. Limited Liability Company
    Name of Member / Manager
79. Statement of Partners
    
    This is to certify that the below named persons intend to carry on business under an assumed or fictitious name as partners in the:

    1. City

    1. County
81. City / County of:
83. First Name
84. Last Name
86. Address1
88. Address2
90. City
91. State
92. Zip
94. First Name
95. Last Name
97. Address1
99. Address2
101. City
102. State
103. Zip
105. First Name
106. Last Name
108. Address1
110. Address2
112. City
113. State
114. Zip
116. First Name
117. Last Name
119. Address1
121. Address2
123. City
124. State
125. Zip
Leave This Blank:


127. 1. Receive an email copy of this form.
128. Email address

     This field is not part of the form submission.

129. Submit

* indicates a required field