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CERTIFICATE OF ASSUMED NAME LT PROACTIVE CARE CLINIC

Friday, April 18, 2014 - 11:20pm

CERTIFICATE OF
ASSUMED NAME
LT PROACTIVE CARE CLINIC
STATE OF MINNESOTA
SECRETARY OF STATE
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 consumers to be able to identify the true owner of a business.
1. List the exact assumed name under which the business is or will be conducted: LT Proactive Care Clinic
2. Principal Place of Business: 855 Jewel Ave North, Lake Elmo, MN 55042
3. List the name and complete street address of all persons conducting business under the above Assumed Name, OR if an entity, provide the legal corporate, LLC, or Limited Partnership name and registered office address: Life Clinic Medical, P.A., 855 Jewel Ave North, Lake Elmo, MN 55042
4. 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 Minnesota Statutes section 609.48 as if I had signed this certificate under oath.
April 4, 2014
/s/Kambiz Farbakhsh, MD,
President/CEO
4/16-4/23/2014


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