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Certificate of Assumed Name

Avera Medical Group Optometry Marshall

May 24, 2012
Marshall Independent

May 25, 26, 2012


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: Avera Medical Group Optometry Marshall

2. Principal place of business. A PO Box by itself is not acceptable: 121 North 3rd Street, Marshall, MN 56258

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. Attach additional sheet(s) if necessary. Avera Marshall 300 S. Bruce Street, Marshall, MN 56258.

4. I, the undersigned, certify that I am signing this document as the person whose signiture is required, or as agent of the person(s) whose signiture would be required who has outhorized 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.

Mary Maertens

President & CEO

Contact Name

Deb Burckhardt


May 14, 2012



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