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November 24, December 1, 2021
OFFICE OF THE MINNESOTA
SECRETARY OF STATE
Certificate of Assumed Name
Minnesota Statutes
Chapter 333
The filing of an assumed name does not provide a user with exclusive rights to that name. The filing is required for consumer protection in order to enable customers to be able to identify the true owner of a            business.
ASSUMED NAME: Black River Repair
PRINCIPAL PLACE OF BUSINESS: 17755 110th St SW Red Lake Falls MN 56750 United States
NAMEHOLDER(S): Name: Samuel D. Paul Mosbeck ADDRESS: 17755 110th St SW Red Lake Falls MN 56750 United States
By typing my name, I, the      undersigned, certify that I am signing this document as the person whose signature is required, or as agent of the person(s) whose signature would be required who has authorized me to sign this document on his/her behalf, or in both capacities. I further certify that I have completed all required fields, and that the information in this document is true and correct and in compliance with the applicable chapter of Minnesota Statutes. I understand that by signing this document I am subject to the penalties of perjury as set forth in Section 609.48 as if I had signed this document under oath.
SIGNED BY: Sam Mosbeck
Mailing Address: 17755
110th St SW Red Lake Falls MN 56750
EMAIL FOR OFFICIAL NOTICES:
mozzman21@outlook.com