Fictitious Business Name Statement - 2014
ADVERTISEMENT
1
2
3YOUR RETURN MAILING ADDRESS
LOS ANGELES
REGISTRAR-RECORDER/ COUNTY CLERK
NAME:
ADDRESS:
CITY:
STATE:
ZIP CODE:
FICTITIOUS BUSINESS NAME STATEMENT
TYPE OF FILING AND FILING FEE (Check one)
□
Original- $26.00
(FOR ORIGINAL FILING WITH ONE BUSINESS NAME ON STATEMENT)
□
New (Amended) Filing- $26.00
(CHANGES IN FACTS FROM ORIGINAL FILING- REQUIRES PUBLICATION)
□
Refile- $26.00
(NO CHANGES IN THE FACTS FROM ORIGINAL FILING)
FOR EACH ADDITIONAL BUSINESS NAME FILED ON SAME STATEMENT, DOING BUSINESS AT THE SAME LOCATION
FOR EACH ADDITIONAL OWNER IN EXCESS OF ONE OWNER
$5.00
-
$5.00
-
:
The following person(s) is (are) doing business as
*
_____________________________________
____________________________________
1.
2.
Print Fictitious Business Name(s)
**_________________________________________|_________________________________
Street address of principal place of business
Mailing address if different
__________________________________________ |_________________________________
City
State
Zip
City
State
Zip
COUNTY
Articles of Incorporation or Organization Number (if applicable): AI #ON_________________________________________________
***
REGISTERED OWNER(S):
1. __________________________________
2. _________________________________
Full Name/Corp/LLC (P.O. Box not accepted)
Full Name/Corp/LLC (P.O. Box not accepted)
__________________________________
_________________________________
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 (P.O. Box not accepted)
Full Name/Corp/LLC (P.O. Box not accepted)
__________________________________
_________________________________
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
IF MORE THAN FOUR REGISTRANTS, ATTACH ADDITIONAL SHEET SHOWING OWNER INFORMATION
****
THIS BUSINESS IS CONDUCTED BY: (Check one)
□
□
□
□
an Individual
a General Partnership
a Limited Partnership
a Limited Liability Company
□
□
□
□
an Unincorporated Association other than a Partnership
a Corporation
a Trust
Copartners
□
□
□
□
a Married Couple
Joint Venture
State or Local Registered Domestic Partners
a Limited Liability Partnership
*****
The date registrant commenced to transact business under the fictitious business name or names listed above on ____________________________
(Insert N/A above if you haven’t started to transact business)
I declare
that all information in this statement is true and correct.
(A registrant who declares as true any material matter pursuant to Section 17913 of the Business and Professions Code that
the registrant knows to be false is guilty of a misdemeanor punishable by a fine not to exceed one thousand dollars ($1,000)).
____________________________________________
_____________________________________
)
REGISTRANT/CORP/LLC NAME (PRINT
TITLE_
____________________
________________________
IF CORP OR LLC, PRINT NAME
REGISTRANT SIGNATURE
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 on the date indicated by the filed stamp in the upper right corner.
NOTICE – IN ACCORDANCE WITH SUBDIVISION (a) OF SECTION 17920, A FICTITIOUS NAME STATEMENT GENERALLY EXPIRES AT THE END OF FIVE YEARS FROM THE DATE ON
WHICH IT WAS FILED IN THE OFFICE OF THE COUNTY CLERK, EXCEPT, AS PROVIDED IN SUBDIVISION (b) OF SECTION 17920, WHERE IT EXPIRES 40 DAYS AFTER ANY CHANGE
IN THE FACTS SET FORTH IN THE STATEMENT PURSUANT TO SECTION 17913 OTHER THAN A CHANGE IN THE RESIDENCE ADDRESS OF A REGISTERED OWNER. A NEW
FICTITIOUS BUSINESS NAME STATEMENT MUST BE FILED BEFORE THE EXPIRATION. EFFECTIVE JANUARY 1, 2014, THE FICTICIOUS BUSINESS NAME STATEMENT MUST BE
ACCOMPANIED BY THE AFFIDAVIT OF IDENTITY FORM.
THE FILING OF THIS STATEMENT DOES NOT OF ITSELF AUTHORIZE THE USE IN THIS STATE OF A FICTITIOUS BUSINESS NAME IN VIOLATION OF THE RIGHTS OF ANOTHER
UNDER FEDERAL, STATE, OR COMMON LAW (SEE SECTION 14411 ET SEQ., BUSINESS AND PROFESSIONS CODE).
THAT THIS COPY IS A CORRECT COPY OF THE ORIGINAL STATEMENT ON FILE IN MY OFFICE.
I HEREBY CERTIFY
BY: _____________________________________________, Deputy
DEAN C. LOGAN, LOS ANGELES COUNTY CLERK
Rev. 01/2014
P.O. BOX 1208, NORWALK, CA 90651-1208
PH: (562) 462-2177
WEB ADDRESS: LAVOTE.NET
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