Form F0050 - Fictitious Business Name Registration
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1Mississippi Secretary of State
FOR OFFICE USE ONLY
Fictitious Business Name Registration
Miss Code Ann. §75-93-1 et seq.
11 F0070
Original Application
or Renewal
(
Applicant’s Legal Name
corporate , LLC, partnership, individual etc.)
:___________________________
Applicant’s address: ____________________________________________________________________________
MS business ID number (if any): _______________________Business email: _______________________________
State of Organization:___________________________________________________________________________
Non-Mississippi businesses must indicate name of state or nation of organization and attach a copy of the
business’s certificate of authority to transact business in Mississippi:
The applicant is a foreign entity:
No
Yes; Certificate of authority is attached with this application.
Fictitious/Business Name: ________________________________________________________________________
Street address(es) of business using name: ___________________________________________________________
NAICS Code / Nature of Business:
_______________________________________
The Applicant, through its undersigned authorized representative, is familiar with the provisions of Mississippi Code Annotated §25-
93-1 et seq. and understands that filing this form creates no exclusive rights in or to the fictitious/business name which is the subject of
this application. Signed this _______ day of __________________, 20_______.
_______________________________________
__________________________________________________________
Signature
Printed Name
_______________________________________
Title
Make Check for $25.00 payable to SECRETARY OF STATE. Mail completed form with payment to SECRETARY OF STATE, PO
BOX 136, JACKSON, MS 39205-0136. For assistance contact a customer service representative at (800) 256-3494. Visit our website at
for forms and instructions.
F0050 7/1/2010
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