Trade Name Registration Form
Pursuant to the provisions of the Code of Laws for the District of Columbia and the OMNIBUS
REGULATORY REFORM ACT OF 1998, the undersigned company, partnership or individual
hereby applies for a Certificate of Trade Name and for that purpose submits the following
statement:
1. FULL LEGAL NAME OF ENTITY OR INDIVIDUAL USING THE TRADENAME:
______________________________________________________________
2. PROPOSED TRADENAME:
______________________________________________________________________________
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3. TYPE OF ENTITY:
___ Sole Proprietor
___ Corporation
___ Limited Liability Company
___ Limited Liability Partnership ___
Limited Partnership ___ General Partnership
4. FEIN NUMBER:
_____________________________________
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5. FULL LEGAL NAME OF PERSON SUBMITTING THIS FORM:
_________________________________________________________________________________________________
6. COMPLETE BUSINESS ADDRESS:
_________________________________________________________________________________________________
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Questions 7 & 8 intended only for corporations, partnerships and limited liability companies.
Question 8 intended only for sole-proprietors, located outside the District of Columbia
7. NAME AND HOME ADDRESS OF ONE OFFICER/DIRECTOR/MANAGER/PARTNER:
Name
_________________________________________________
Title
_________________________________________________
Address
______________________________________________________________
8. NAME AND ADDRESS OF REGISTERED AGENT:
Name
__________________________________________________
Company
__________________________________________________
Address
__________________________________________________
I certify that the information in this TRADE NAME REGISTRATION APPLICATION in the District
of