Form Dn-18/f-18 - Application For Fictitious Name Form - Arkansas Secretary Of State
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1Arkansas Secretary of State
M
M
ark
artin
State Capitol • Little Rock, Arkansas 72201-1094
501-682-3409 •
Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock
INSTRUCTIONS: File with the Secretary of State's Office, Business Services Division, State Capitol, Little Rock,
Arkansas 72201-1094. A copy will be returned to the entity and must be filed with the County Clerk in the coun-
ty in which the entity’s registered office is located (unless registered office is in Pulaski County).
APPLICATION FOR FICTITIOUS NAME
Select entity type:
[
] For-Profit Corporation
[
] Nonprofit Corporation
($25.00 fee)
($25.00 fee)
[
] General Partnership
[
] Limited Partnership
($15.00 fee)
($15.00 fee)
[
] LLC
[
] LLP
($25.00 fee)
($15.00 fee)
[
] LLLP
($15.00 fee)
Pursuant to the provisions of Arkansas law, the undersigned entity hereby applies for the use of a fictitious
name and submits herewith the following statement:
1.
The fictitious name under which the business is being, or will be, conducted by this entity is:
___________________________________________________________________________
2.
The character of the business being, or to be, conducted under such fictitious name is:
___________________________________________________________________________
3.
a) The entity name of the applicant and its date of qualification in Arkansas: ____________________
___________________________________________________________________________
b) The entity is [
] domestic
[
] foreign (state of domestic registration) ________________
c) The location (city and street address) of the registered office of the applicant entity in Arkansas is:
__________________________________________________________________________
Street
City
State
ZIP Code
I understand that knowingly signing a false document with the intent to file with the Arkansas
Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or impris-
onment up to 30 days.
Authorizing Officer _________________________________________________________________
(Type or Print)
Authorized Signature: ______________________________________________________________
(Chairman, Partner or other authorized person)
Address: _________________________________________________________________________
Fee: see top of page. Make payable to Arkansas Secretary of State.
DN-18/F-18/Rev. 4/06
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