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This is a New York form that can be used for General within Local County, Erie.
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(Assumed Name Certificate pursuant to General Business Law §130) I hereby certify that I am conducting or transacting business under the name or designation of at (Address) Business Certificate , (City/Town) , County of Erie, State of New York ____________. (Zip code) My full name is (Print or Type Name) (If under 18 years of age) I am ___________ years of age. and I reside at 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 Print name: ACKNOWLEDGEMENT IN NEW YORK STATE (RPL 309-A) State of New York County of Erie } SS.: day of , before me, the undersigned, personally On the 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. (signature and office of individual taking acknowledgement) Affix seal/stamp American LegalNet, Inc. www.FormsWorkflow.com