Certificate of Business: Fictitious Firm Name
Please Return with $20.00 to:
Please Select One:
Lincoln County Clerk
P.O. Box 90
___New Application
Pioche, NV 89043
___Renewal of Application
___Add an individual or corporation
Please Print or Type
The expiration date for such certificates shall be the last day of the sixtieth month from the date of filing.
The undersigned do/does hereby certify that __________________________________________________________
(Name of individual, corporation, partnership, or trust)
with mailing address of _________________________________,______________________,________,__________
(Mailing Address for notification of renewal) (Street)
(City)
(State)
(Zip)
is/are conducting a ____________________________business in _________________, Nevada, under the fictitious
(Type of Business)
(City)
name of ______________________________________________________________________________________
(Fictitious Firm Name) or (Doing Business As)
and that said firm is composed of the following person(s) whose name(s) and address(es) are as follows:
(1) ______________________________________________
___________________________________________
Full Name and title (Type or Print)
Signature
Date
___________________________________________________________________________________________
Street Address of Business or Residence
City, State, Zip
_________________________________________________________________________________________________________________________________________________________
Mailing Address, if different from above
City, State, Zip
(2) ______________________________________________
___________________________________________
Full Name and title (Type or Print)
Signature
Date
___________________________________________________________________________________________
Street Address of Business or Residence
City, State, Zip
_________________________________________________________________________________________________________________________________________________________
Mailing Address, if different from above
City, State, Zip
(3) ______________________________________________
___________________________________________
Full Name and title (Type or Print)
Signature
Date
___________________________________________________________________________________________
Street Address of Business or Residence
City, State, Zip
_________________________________________________________________________________________________________________________________________________________
Mailing Address, if different from above
City, State, Zip
(For additional names or execution of additional notary signatures, please attach a separate sheet.)
Subscribed and sworn to before me this __________ day of
Certificate filed on ________20______Expires on____________20_____
______________________________________, 20________.
_________________________________________________
Certificate File Number _______________
Notary Public