Fillable ASSUMED BUSINESS NAME (DBA) APPLICATION (Cook County Clerk)

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ASSUMED BUSINESS NAME (DBA) APPLICATION (Cook County Clerk)

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The ASSUMED BUSINESS NAME (DBA) APPLICATION (Cook County Clerk) form is 3 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Cook County Clerk

BROWSE COOK COUNTY CLERK (IL) FORMS

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A. Is your business a Corporation (excluding Professional), LLC, LLP or a Non-Profit?
If yes, please register with the Secretary of State, Corporate Division. The Cook County Clerk's office does not file Corporations, LLC, LLP or Non-Profit organizations.
If registering your Assumed Business Name with the ending of PC, SC or LTD the entity must be a registered professional service corporation with the Illinois
Secretary of State’s Office and at the time of filing must provide the following:
1. Articles of Incorporation from the Illinois Secretary of State’s Office, if in business for less than a year
2. Certificate of Good Standing from the Illinois Secretary of State’s Office, if in business for more than a year
B. Contact Information (your application will not be processed if all fields required (*) below are not completed).
C. Assumed Business Name
The undersigned is/are conducting or transacting business under the
D. Nature of Business
E. Business Addresses within Cook County
F. Business Owner(s)/Partner(s)
The true and real full names of all new person(s) owning, conducting or transacting the business are as follows (add notarized attachment for additional owners/partners):
*Address 1
Address 2
*City
*State
*Zip
*Contact First Name
*Contact Last Name
*Contact Email
*Contact Phone
Assumed Business Name of:
ASSUMED BUSINESS NAME (DBA) APPLICATION
STATE OF ILLINOIS ) Registration Number: ______________
(For Office Use Only)
COUNTY OF COOK )
The nature of business conducted or transacted is (be descriptive):
Cook County Address 1 Address 2 (apt., suite, unit) City Zip
No - please complete the form below.
Page 1 of 3
Owner/Partner Full Name
Partner Type
(Individual,
Company or Trust)
Trust/Company
(If trust or company)
Title
(If company)
Complete Address
(include city, state, zip /
if individual, list residential address)
COOK COUNTY CLERK'S OFFICE
DAVID ORR, CLERK
DAVID ORR, Cook County Clerk
VITAL STATISTICS, P.O. BOX 641070, CHICAGO, IL 60664-1070
ATTN: ASSUMED NAME UNIT
The Assumed Business Names application fee is $50.00. The application fee is non-refundable.
Please make all checks payable to "Cook County Clerk David Orr" for $
a Notary Public in and for said County of State, do hereby certify that
[record owner(s)/partner(s) name(s) below]
is/are personally known to me to be the same person(s) whose name(s) subscribed to the foregoing instrument appear before me this day in person
and acknowledged that he/she/they has/have read and signed said instrument and that each of the statements contained, and each thereof, are true.
Page 2 of 3
Print Name Signature
Dated this day of 20
I,
day ofMy commission expires on the 20
Print Name Signature
Print Name Signature
Print Name Signature
Notary Stamp
Signature of Notary Public
COPY OF LEGAL NOTICE TO BE PUBLISHED
Notice is hereby given, pursuant to “An Act in relation to the use of an Assumed Business
Name in the conduct or transaction of Business in the State,” as amended, that a certification
was registered by the undersigned with the County Clerk of Cook County.
(For Office Use Only)
The true and real full name(s) and residence address of the owner(s)/partner(s) is:
COOK COUNTY CLERK'S OFFICE
DAVID ORR, CLERK
on the
Under the Assumed Business Name of
with the business located at
Owner/Partner Full Name
Complete Address
(include city, state, zip /
if individual, list residential address)
Page 3 of 3
Registration Number:
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ASSUMED BUSINESS NAME (DBA) APPLICATION (Cook County Clerk)

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Completed 8 January 2022

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