Free Microsoft Word - FORM21.DOC - Oklahoma

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TRADE NAME REPORT
TO: OKLAHOMA SECRETARY OF STATE 2300 N. Lincoln Blvd., Room 101, State Capitol Building Oklahoma City, Oklahoma 73105-4897 (405) 522-4560

The undersigned business entity, in order to do business in Oklahoma under a name other than its legal name, hereby submits the following trade name report pursuant to Title 18, Oklahoma Statutes, Section 1140:

1.

The trade name under which the business is carried on in Oklahoma is:

____________________________________________________________________________________ (The trade name must be different than the legal name listed in Item 4 below.) 2. Business is carried on under such trade name at the following address(es):

____________________________________________________________________________________ ____________________________________________________________________________________ 3. A brief description of the kind of business being transacted under such trade name:

4.

The legal name of the "corporation or business entity" doing business under the trade name is:

____________________________________________________________________________________ 5. The type of "business entity" filing the trade name report is (check one of the following): ( ) corporation ( ) business trust ( ) limited liability company ( ) unincorporated business ( ) common law trust ( ) partnership

6.

The business entity was formed in the state of:________________________________________

(REVERSE SIDE OF FORM MUST BE SIGNED AND DATED.)

COMPLETE ONLY THE ACKNOWLEGEMENT WHICH APPLIES TO THE BUSINESS ENTITY FILING THIS TRADE NAME REPORT.

BUSINESS ENTITY ACKNOWLEDGEMENT

I/we, being duly authorized to sign on behalf of the above named business entity, do hereby execute this report on the day of , .

_________________________________________ Signature _________________________________________ Type or Print Name _________________________________________ Title

CORPORATION ACKNOWLEDGMENT

I/we, being duly authorized to sign on behalf of the above named corporation, do hereby execute this report on the day of , .

____________________________________ President by its ATTEST: ____________________________________ by its Secretary

(SOS FORM 0021-12/01)