Fillable Fictitious Business Name Statement printable pdf download

275-321

[Rev. 01/15]

STEVE MANNING, Alameda County Clerk-Recorder

1106 Madison Street, Oakland, CA 94607

Telephone (510) 272-6362

FICTITIOUS BUSINESS NAME STATEMENT

PURSUANT TO BUSINESS AND PROFESSIONS CODE SECTIONS 17900-17930

USE BLACK OR DARK BLUE INK ONLY

FILE NUMBER:

For current filing fees call (510) 272-6362, or visit our website at

DO NOT WRITE ABOVE THIS LINE

PLEASE READ INSTRUCTIONS ON BACK OF THIS FORM – TYPE OR PRINT LEGIBLY

A FICTITIOUS BUSINESS NAME(S) *

Street Address of Principal Place of Business (P.O. Box not acceptable) ** City

County

State

Zip

Mailing Address (Optional)

City

County

State

Zip

1 Show full name of 1

Registrant. (If Registrant is Corporation,

2 Show full name of 2

Registrant if any. (If Registrant is

LLC or LLP, show full name of Entity.) ***

Corporation, LLC or LLP, show full name of Entity.) ***

Residence Street Address (P.O. Box not acceptable)

City

State

Zip

City

State

Zip

(If a corporation or LLC, show state where registered.)

3 Show full name of 3

Registrant if any. (If Registrant is Corporation,

4 Show full name of 4

Registrant if any. (If Registrant is

LLC or LLP, show full name of Entity.) ***

Corporation, LLC or LLP, show full name of Entity.) ***

Residence Street Address (P.O. Box not acceptable)

City

State

Zip

City

State

Zip

(If a corporation or LLC, show state where registered.)

D BUSINESS

an Individual

Married Couple

State or local registered domestic partners

Co-partners

CONDUCTED

a Joint venture

a General partnership

a Limited liability partnership

a Trust

BY: ****

a Corporation

a Limited partnership

a Limited liability company

(Check only 1 box)

an Unincorporated association other than a partnership

The registrant has not yet begun to transact business using the fictitious business name listed above.

The registrant began to transact business using the fictitious business name(s) listed above on ___________________________.*****

(Date)

I declare that all information on this statement is true and correct. (A registrant who declares as true any material matter pursuant to Section 17913 of the

Business and Professions Code that the registrant knows to be false is guilty of misdemeanor punishable by a fine not to exceed one thousand dollars [$1,000].)

NOTICE: In accordance with subdivision (a) of Section 17920, a fictitious name statement generally expires at the end of five years from the date on

which it was filed in the office of the county clerk, except, as provided in subdivision (b) of section 17920, where it expires 40 days after any change in

the facts set forth in the statement pursuant to section 17913 other than a change in the residence address of a registered owner. A new fictitious

business name statement must be filed before the expiration.

The filing of this statement does not of itself authorize the use in this state of a fictitious business name in violation of the rights of another under federal, state, or

common law (see Section 14411 et seq., Business and Professions Code).

SIGNATURE OF REGISTRANT ______________________________________________________________________________________________

PRINT NAME _____________________________________________________________________________________________________________

PRINT NAME OF PERSON SIGNING. PRINT TITLE IF REQUIRED (See back of form, Section F).

THIS STATEMENT WAS FILED WITH THE CLERK-RECORDER OF ALAMEDA COUNTY ON THE DATE INDICATED BY THE FILE STAMP ABOVE

White - Clerk’s Copy

Yellow Copy - Bank & other Required Needs (Certified)

Pink Copy - Newspaper Copy

Goldenrod Copy - Registrant’s Copy