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November 7, 2013

Assumed Name


Office of the Minnesota

Secretary of State

Assumed Name

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 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: Maplewood Court Assisted Living

2. Principal Place of Business: 310 7th St. NE, Fulda MN 56131.

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, LC, or Limited Partnership name and registered office address: Maple Lawn Nursing Home, Inc., 400 7th St. NE, Fulda, MN 56131.

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 Section 609.48 as if I had signed this document under oath.

Dated: September 25, 2013

Arlan Swanson, Administrator/CEO

F-10-30,11-6


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