Statement Of Abandonment Of Use Of Fictitious Business Name - California Secretary Of State
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1
2YOUR RETURN MAILING ADDRESS
LOS ANGELES
REGISTRAR-RECORDER/ COUNTY CLERK
NAME:
ADDRESS:
CITY:
STATE:
ZIP CODE:
STATEMENT OF ABANDONMENT
OF USE OF FICTITIOUS BUSINESS NAME -
FILING FEE $26.00
FILE NO:
DATE FILED:___________________________________________
Name of Business(es)___
__
Street Address, City, State, Zip Code________________________________________________________________
REGISTERED OWNER(S):
1. __________________________________
2. _________________________________
Full Name/Corp/LLC
Full Name/Corp/LLC
__________________________________
_________________________________
Residence Address
Residence Address
__________________________________
_________________________________
City
State
Zip
City
State
Zip
__________________________________
_________________________________
If Corporation or LLC – Print State of Incorporation/Organization
If Corporation or LLC – Print State of Incorporation/Organization
3. __________________________________
4. _________________________________
Full Name/Corp/LLC
Full Name/Corp/LLC
__________________________________
_________________________________
Residence Address
Residence Address
__________________________________
_________________________________
City
State
Zip
City
State
Zip
__________________________________
_________________________________
If Corporation or LLC – Print State of Incorporation/Organization
If Corporation or LLC – Print State of Incorporation/Organization
Business was conducted by: (Check one of the following)
( )
( )
( )
( )
an Individual
a General Partnership
a Limited Partnership
a Limited Liability Company
( )
( ) a
( )
( )
an Unincorporated Association other than a Partnership
Corporation
a Trust
Copartners
( )
( )
( )
( )
a Married Couple
Joint Venture
State or Local Registered Domestic Partners
a Limited Liability Partnership
I declare that all information in this statement is true and correct.
(A registrant who declares as true information which he or she knows to be false is guilty of a crime.)
REGISTRANT (NAME/CORP/LLC NAME
______________________________TITLE:____________________________
(PRINT)
REGISTRANT SIGNATURE__________________________________IF CORP OR LLC, PRINT NAME____________________
If corporation, also print corporate title of officer. If LLC, also print title of officer or manager.
This statement was filed with the County Clerk of LOS ANGELES County on the date indicated by the filed stamp in the
upper right corner.
I HEREBY CERTIFY THAT THIS COPY IS A CORRECT COPY OF THE ORIGINAL STATEMENT ON FILE IN MY OFFICE.
DEAN C. LOGAN, LOS ANGELES COUNTY CLERK
BY:__________________________________________, Deputy
Rev. 01/13
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