Prescribed by Gregory R. Francis, Lieutenant Governor Office of the Lieutenant Governor 5049 Kongens Gade Charlotte Amalie, St. Thomas, VI 00802 FOR OFFICE USE ONLY Approved: _____________________________ Date: _________________________________ Fee: $50.00 Division of Corporation and Trademarks RENEWAL OF TRADE NAME REGISTRATION 1. The trade name to be renewed is: ____________________________________________________ 2. Registration number: ______________ Date of original registration: _______________________ 3. The applicant is: (Check the appropriate box) [ ] an individual [ ] a Virgin Islands Corporation, Charter No._______________________ [ ] a General Partnership [ ] a Foreign Corporation, state of ____________________________ [ ] a Limited Partnership [ ] a VI Limited Liability Company, Charter No.___________________ [ ] an unincorporated association [ ] a Foreign Limited Liability Company, state of ________________ 4. The name(s) of the applicant designated in item 3 is (are): __________________________________________________________________________________ __________________________________________________________________________________ NOTE: When the applicant is a partnership, the name of the partnership must appear on this line. 5. The business address of the applicant is: ______________________________________________ (Street Address) ______________________, _____________________, ____________________, ________________ (City, Village or Township) (Island or County) (State) (Zip Code) 6. Complete only if applicant is a partnership: NAMES OF ALL GENERAL PARTNERS COMPLETE RESIDENCE ADDRESS (Please attach a separate sheet if additional space is needed.) ___________________________________ __________________________________ ___________________________________ __________________________________ ___________________________________ __________________________________ ___________________________________ __________________________________ ___________________________________ __________________________________ This document is signed by a corporate officer, general partnership, association member or officer, or individual applicant. By: ____________________________________ _______________________________________ (Please Print Name and Title)