Statement Form Of Abandonment Of Use Of Fictitious Business Name
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2P.O. Box 751, Riverside, CA 92502-0751 -- (951) 486-7000
38-686 El Cerrito Road, Palm Desert, CA 92211 -- (760) 863-8732
Assessor, County Clerk-Recorder
OFFICE OF THE COUNTY CLERK
STATEMENT OF ABANDONMENT OF USE OF FICTITIOUS BUSINESS NAME
Page __1__ of _____
--USE BLACK INK ONLY --
MUST BE TYPED OR PRINTED
FILING FEE $24.00
County of Riverside
Receipt # _________________
The following fictitious business name(s)
has been abandoned by the following person(s):
.
FILE NO
__________________________________
1a.
_____________________________________________________________________________________________________________________________
1b.
Fictitious Business Name(s) to be Abandoned at Same Address - Attach supplemental Sheet Provided by Clerk's Office if Necessary
______________________________________________________________________________________________________________________________
1c.
Business Address, City, State and Zip Code, AND COUNTY of Principal Place of Business (No P.O. or Mail Boxes)
2.
_______________________________________________________________
_______________________________________________________________
Full Name of Registrant - First, Middle and Last
Full Name of Registrant - First, Middle and Last
_______________________________________________________________
_______________________________________________________________
Residence Address
Residence Address
_______________________________________________________________
_______________________________________________________________
City
State
Zip
City
State
Zip
_______________________________________________________________
_______________________________________________________________
(If corporation or limited liability company, state of incorporation or organization)
(If corporation or limited liability company, state of incorporation or organization)
_______________________________________ _______________________
_______________________________________________________________
Full Name of Registrant - First, Middle and Last
Full Name of Registrant - First, Middle and Last
_______________________________________________________________
_______________________________________________________________
Residence Address
Residence Address
_______________________________________________________________
_______________________________________________________________
City
State
Zip
City
State
Zip
_______________________________________________________________
_______________________________________________________________
(If corporation or limited liability company, state of incorporation or organization)
(If corporation or limited liability company, state of incorporation or organization)
3.
This business is conducted by:
(If More Than 4 Registrants - Attach Additional Sheet Showing Owner Information)
Individual
Married Couple
Trust
Corporation
a General Partnership
a Limited Partnership
Co-Partners
Joint venture
Limited Liability Company
Limited Liability Partnership
an Unincorporated Association - other than a Partnership
State or Local Registered Domestic Partnership
4.
The fictitious business name(s) referred to above was filed in Riverside County on ________________________________________________________
I declare that all the information in this statement is true and correct. (A registrant who declares as true, information
5.
which he or she knows to be false is guilty of a crime.)
Signature ________________________________________________________________________________________________________________________
Typed or Printed Name _____________________________________________________________________________________________________________
If Limited Liability Company/Corporation - Title ________________________________________________________________________________________
This statement was filed with the County Clerk of Riverside County on date indicated by file stamp above
.
SEE REVERSE SIDE FOR INSTRUCTIONS
ACR 863 (Rev. 11/2014)
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