Certificate For Registration Of Trade Name

(For use by sole proprietors, partnerships or associations of individuals other than corporations) Daytime Telephone No. ______________________ CERTIFICATE For Registration of Trade Name under Title 11, Chapter 21 of the Virgin Islands Code ___o__ To: The Lieutenant Governor of the Virgin Islands TERRITORY OF THE VIRGIN ISLANDS JUDICIAL DISTRICT OF ST. __________________ The undersigned parties, comprising a co-partnership or an association of individuals other than a corporation conducting or intending to conduct a business in the Virgin Islands, hereby request that the trade name set forth below, under which such business shall be conducted, be registered in accordance with the provisions of Chapter 21, Title 11 of the Virgin Islands code, and we certify the following: Print Print Print Trade Name: ______________________________________________________________________ _________________________________________________________________ _______________________________________________________________ Nature of Business: Location of Business: True and real names of all parties conducting or having an interest in the business Print __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ P.O. Box Address ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ Non-resident (Partners or members of the association, residing in the Virgin Islands sign below. partners or members sign on reverse side of this form.) Sign ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ Subscribed and sworn to before me this _______ day of _________________________ _____________________________________ Notary Public STATE OF ________________________________ ) COUNTRY OF ____________________________ ) *Registered Tradenames must be renewed every 2 years. (Over) American LegalNet, Inc. www.FormsWorkflow.com The undersigned, non-resident of the Virgin Islands, doing business in the Virgin Islands as partner or member in the firm under the trade name ________________________________________ ________________________________________ hereby subscribes to the certificate on the reverse side of this form, and appoints _________________________________________________________ a person residing and having an office or place of business located at _______________________________________ __________________________________________________________________________________ as his agent upon whom process against the undersigned may be served in an action founded upon a liability incurred in the Virgin Islands _____________________________________________ Signature Subscribed and sworn to before me this _______ day of _________________________ _____________________________________ Notary Public STATE OF ________________________________ ) COUNTRY OF ____________________________ ) The undersigned, non-resident of the Virgin Islands, doing business in the Virgin Islands as partner or member in the firm under the trade name ________________________________________ ________________________________________ hereby subscribes to the certificate on the reverse side of this form, and appoints _________________________________________________________ a person residing and having an office or place of business located at _______________________________________ __________________________________________________________________________________ as his agent upon whom process against the undersigned may be served in an action founded upon a liability incurred in the Virgin Islands _____________________________________________ Signature Subscribed and sworn to before me this _______ day of _________________________ _____________________________________ Notary Public STATE OF ________________________________ ) COUNTRY OF ____________________________ ) Certificate of county clerk or similar officer must accompany the notary's acknowledgment. Section 1204, Title 11 of the Virgin Islands Code provides: "A trade name registered in accordance with the provisions of V.I.C. Title 11, Chapter 21 shall not be the same as nor so similar as to cause confusion with the trade name of any person, partnership, association or corporation, foreign or domestic, doing business under such trade name in the Virgin Islands." A fee of $25.00 must accompany two originally executed certificates. If the certificates are mailed, attach a money order or check payable to the "Government of the Virgin Islands", but address the envelope to "Office of the Lieutenant Governor, Division of Corporation and Trademarks, 5049 Kongens Gade, St. Thomas USVI 00802-6487. American LegalNet, Inc. www.FormsWorkflow.com