TNR12 THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF CORPORATIONS AND TRADEMARKS TRADE NAME REGISTRATION RENEWAL TRADE NAME TO BE RENEWED _______________________________________________________ REGISTRATION NUMBER ____________________________________ DATE OF ORIGINAL REGISTRATION ____________________________________ THE TRADE NAME IS REGISTERED (please select one) – ___ AS A SOLE PROPRIETORSHIP/PARTNERSHIP __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ UNDER A FOREIGN/DOMESTIC CORPORATION __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ UNDER A FOREIGN/DOMESTIC LIMITED LIABILITY CO. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ UNDER A LIMITED LIABLITY PARTNERSHIP __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ UNDER A LIMITED LIABILITY LIMITED PARTNERSHIP __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ UNDER A LIMITED PARTNERSHIP __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ AS A NON PROFIT CORPORATION __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ______________________________________________________ _______________________________________________________ FIRST NAME LAST NAME MAILING ADDRESS ______________________________________________________ _______________________________________________________ TITLE CITY ISLAND ZIP CODE ______________________________________________________ _______________________________________________________ SIGNATURE EMAIL ADDRESS TRADE NAME RENEWAL FEE - $50.00. PLEASE BE REMINDED THAT ALL TRADE NAME REGISTRATIONS MUST BE RENEWED BI-ANNUALLY (EVERY TWO (2) YEARS), ON THE ANNIVERSARY OF ORIGINAL REGISTRATION. FAILURE TO DO SO WILL RESULT IN THE CANCELLATION OF THE REGISTRATION. FOR OFFICIAL USE ONLY DATE RECEIVED DOCUMENTS RECEIVED BY PAYMENT AMOUNT RECEIVED PAYMENT TYPE RECEIPT NO. I DECLARE, UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE UNITED STATES VIRGIN ISLANDS, THAT ALL STATEMENTS CONTAINED IN THIS APPLICATION, AND ANY ACCOMPANYING DOCUMENTS, ARE TRUE AND CORRECT, WITH FULL KNOWLEDGE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE SUBJECT TO INVESTIGATION AND THAT ANY FALSE OR DISHONEST ANSWER TO ANY QUESTION MAY BE GROUNDS FOR DENIAL OR SUBSEQUENT REVOCATION OF REGISTRATION. PROVIDE NAME AND BUSINESS ADDRESS OF ENTITY Comment [t1]: Trade name to be renewed. Comment [t2]: Registration number, as provided by Corporations and Trademarks. Comment [t3]: Date of original registration. Comment [t4]: Select entity type and provide entity name and address. Comment [t5]: Name, title, address, email address and signature of person executing this document.