Renewal Of Trade Name Registration

FOR OFFICE USE ONLY Prescribed by VARGRAVE A. RICHARDS, Lieutenant Governor Office of the Lieutenant Governor 5049 Kongens Gade Charlotte Amalie, St. Thomas, VI 00802-6487 Approved: _____________________________ Date: _________________________________ Fee: $50.00 Division of Corporation and Trademarks Tel. (340) 776-8515 Fax. (340) 776-4612 RENEWAL OF TRADE NAME REGISTRATION 1. The trade name to be renewed is: ____________________________________________________ 2. Registration number: ______________ Date of original registration: _______________________ 3. The applicant is: (Check the appropriate box) [ [ [ [ ] ] ] ] an individual a General Partnership a Limited Partnership an unincorporated association [ [ [ [ ] ] ] ] a Virgin Islands Corporation, Charter No._______________________ a Foreign Corporation, state of ____________________________ a VI Limited Liability Company, Charter No.___________________ a Foreign Limited Liability Company, state of ________________ 4. The name(s) of the applicant designated in item 3 is (are): __________________________________________________________________________________ __________________________________________________________________________________ NOTE: When the applicant is a partnership, the name of the partnership must appear on this line. 5. The business address of the applicant is: ______________________________________________ (Street Address) ______________________, _____________________, ____________________, ________________ (City, Village or Township) (Island or County) (State) (Zip Code) 6. Complete only if applicant is a partnership: NAMES OF ALL GENERAL PARTNERS (Please attach a separate sheet if additional space is needed.) COMPLETE RESIDENCE ADDRESS __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ This document must be signed by a corporate officer, a general partner, an individual applicant, an association member and/or officer. By: ____________________________________ _______________________________________ (Please Print Name and Title) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ American LegalNet, Inc. www.FormsWorkflow.com