Business Certificate (Assumed Name Certificate Pursuant To GBL § 130)

Business Certificate (Assumed Name Certificate pursuant to General Business Law 247130) I hereby certify that I am conducting or transacting business under the name or designation of (Name of business) at , County of Erie, ( Address) (City / Town) State of New York . (Zip Code) My name is (Print or Type Name) ( First ) ( Middle Initial - if used ) ( Last ) I reside at (Address) (City/Town) (State/Zip Code) I am years of age. (Required-- ONLY if under 18 years of age) I further certify that I am the successor in interest to the person or persons heretofore using such name or names to carry on or conduct or transact business. In Witness Whereof, I have signed this certificate on (date) Sign: Print name: (Name should appear same as above) State of New York County of Erie } SS.: On the day of , before me, the undersigned, personally (date) (month) (year) appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s) acted, executed the instrument. Affix seal/stamp (signature and office of individual taking acknowledgement) 447 - 1 American LegalNet, Inc. www.FormsWorkFlow.com