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Declaration of Tradename and Assignee (Arizona)

This form is a declaration of a trade name and a trade name assignee in Arizona. The form provided here is simply a sample of what the actual Form CF0043 looks like.

Corporations Division
Arizona Corporation Commission
1300 W. Washington
Phoenix, AZ 85007

(or)

400 W. Congress
Tucson, AZ 85701

www.cc.state.az.us


DECLARATION OF HOLDER OF TRADENAME

Use the following form only if you have, or have been assigned, a pre-existing trade name or trademark. Please select and complete the applicable section, do not complete both sections, use one or the other. Then indicate your title, sign and date the document.

I/We _________________________________________ the undersigned incorporator(s)/Officer(s)

of _________________________________________,

____ a proposed Arizona corporation/limited liability company

____ a foreign corporation/limited liability company organized under the laws

of _________________________________________ [Jurisdiction/State] under penalty of law do hereby attest that:

I/We am the assignee(s) of the ____ Trade name ____ Trademark

_________________________________________,

on file with the Office of the Arizona Secretary of State.

DECLARATION OF TRADENAME ASSIGNEE

I/We _________________________________________ the undersigned incorporator(s)/Officer(s)

of _________________________________________,

____ a proposed Arizona corporation/limited liability company

____ a foreign corporation/limited liability company organized under the laws of , under penalty of Jurisdiction/State law do hereby attest that:

I/We am the holder(s) of the ____ Trade name ____ Trademark

_________________________________________,

and that an assignment authorizing the undersigned to use this name for any and all lawful business purposes has been filed with the Office of the Arizona Secretary of State.

Name(s): _________________________________________

Address(es): _________________________________________

Signature(s): _________________________________________

Date: _________________________________________

Title(s): _________________________________________

PLEASE NOTE: Pursuant to A.R.S. ยงยง10-1632.A. & 10-11633.A, any person who signs any statement with the commission that is known to the person as false in any material respect is guilty of a class 5 felony. Please make sure that you are the holder or assignee of the trade name/trademark before signing.

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