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Amended Assume Name for LT Proactive Care Clinic

Monday, August 28, 2017 - 11:22pm

Office of the Minnesota Secretary of State
Assumed Name |
Amendment to
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 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: (Required) LT Proactive Care Clinic
2. Principal Place of Business: (Required) 8362 Tamarack Village, Suite 119-401, Woodbury, MN 55125
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: (Required) Attach additional sheet(s) if necessary. Life Clinic Medical, LLC, 8362 Tamarack Village, Suite 119-401, Woodbury, MN 55125
4. This certificate is an amendment of Certificate of Assumed Name File Number: 750037400058
Originally filed on: 4/4/2014
Under the name (list the previous name only if you are amending that name):
5. I, the undersigned, certify that 1 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.
Date Aug, 22, 2017
Kambiz Farbakhsh, M.D., President/CEO
08/23/2017-08/30/2017


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