Statement of Trade Name of an Individual

Please complete the form and click 'Submit'. Fields followed by "*" are required.
This document is entitled to be filed pursuant to sections 7-71-103, CRS
The true name of the individual delivering this statement is
Last Name *   First Name * Middle Name Suffix
The street address of such person's usual place of business and, if different, such person's mailing address are
Street Address
Mailing Address
Address 1: *
Address 2:
City: *
State: *
Zip / Postal Code: *
Province:
Country:
Address 1:
Address 2:
City:
State:
Zip / Postal Code:
Province:
Country:
The trade name under which such person transacts business or contemplates transacting business is
Trade Name: *
A brief description of the kind of business transacted or contemplated to be transacted in this state under such trade name is
Brief Description: *
(Caution: Leave blank if the document does not have a delayed effective date or time. Stating a delayed effective date or time has significant legal consequences. Read instructions before entering a date or time.)

Delayed effective date/time (mm/dd/yyyy hour:minute am/pm): (example: 01/30/2004 08:00 am)
Note: delayed effective date cannot be more than 90 days after today. If a date greater than 90 days is used, this document will become effective on the 90th day.
(If the following statement applies, adopt the statement by marking the box and include an attachment.)
This document contains additional information as provided by law. Yes        No       
Email Address (Optional)
Our office can send you email notifications about due dates and other events affecting this business record. Information about email notifications.

Email address will not be sold or otherwise disclosed by our office, and your email address will not appear on your filed document.

Do you want to sign up for email notifications?
Yes. Send my notifications to this email address:
No. I don't want to sign up for email notifications.
Notice:

Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the individual's act and deed, or that the individual in good faith believes the document is the act and deed of the person on whose behalf the individual is causing the document to be delivered for filing, taken in conformity with the requirements of part 3 of article 90 of title 7, C.R.S., and, if applicable, the constituent documents, and the organic statutes, and that the individual in good faith believes the facts stated in the document are true and the document complies with the requirements of that Part, the constituent documents, and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the secretary of state, whether or not such individual is named in the document as one who has caused it to be delivered.


The true name and mailing address of the individual causing this document to be delivered for filing are
Last Name *   First Name * Middle Name Suffix
Address 1: *
Address 2:
City: *
State: *
Zip/Postal Code: *
Province:
Country:
(If 'Yes' is selected, include an attachment with the true name and mailing address of additional individuals.)
Additional individuals are causing this document to be delivered for filing. 		Yes
No
Disclaimer:

This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, and are furnished without representation or warranty. While this form/cover sheet is believed to satisfy minimum legal requirements as of its revision date, compliance with applicable law, as the same may be amended from time to time, remains the responsibility of the user of this form/cover sheet. Questions should be addressed to the user's legal, business or tax advisor(s).