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CERTIFICATE OF ASSUMED BUSINESS NAME For person (sole proprietorships, associations, or general partnerships) engaged in business under a name other than their own (DBA) State of Indiana, County of Brown NAME OF NATURE OF PHYSICAL ADDRESS OF BUSINESS: MAILING ADDRESS OF BUSINESS: PRINTED NAMES AND RESIDENCES OF MEMBERS OF BUSINESS: SECTION TO BE COMPLETED BY/IN PRESENCE OF NOTARY PUBLIC I HEREBY CERTIFY THAT I HAVE PERSONAL KNOWLEDGE OF THE FACTS STATED ABOVE AND THAT EACH OF THEM ARE TRUE. Member's Signature & Capacity Printed Name SUBSCRIBED AND SWORN TO BEFORE ME, THIS SIGNATURE OF NOTARY PRINTED NAME COUNTY OF RESIDENCE EXPIRATION OF COMMISSION: THIS INSTRUMENT PREPARED BY: I affirm, under the penalties for perjury, that I have taken reasonable care to redact each Social Security number in this document, unless required by law (Name)