Certificate No.
__________________ (for
office use only)
Name
of Business:
Nature
of Business:
Address(es) where business is to be conducted or transacted
in this county:
(Street)
(City,State,Zip) (Phone)
(Street)
(City,State,Zip) (Phone)
Name(s) and residence address(es) of the person(s) owning,
conducting or transacting business:
(Name)
(Name)
(Residence)
(Residence)
(City,State,Zip)
(Phone)
(City,State,Zip)
(Phone)
(Name)
(Name)
(Residence)
(Residence)
(City,State,Zip)
(Phone)
(City,State,Zip)
(Phone)
STATE
OF ILLINOIS )
COUNTY OF WILL ) SS
This is to certify that the undersigned intend(s) to conduct the
above named business from the location(s) indicated and that the true or
real full name(s) of the person(s) owning, conducting or transacting the
business is/are correct as shown.
_________________________________
(signature)
_________________________________
(signature)
_________________________________
(signature)
_________________________________
(signature)
The foregoing instrument was
acknowledged before me by the person(s) intending to conduct
the business this
_________ day of _________________, ______.
(Seal)
__________________________________________
Notary Public or County
Clerk (Signature)
