County of Tehama
Clerk & Recorder
633 Washington St., Room 11
PO Box 250
Red Bluff, CA 96080
(530) 527-3350
STATEMENT OF ABANDONMENT OF USE OF FICTITIOUS BUSINESS NAME
ORIGINAL FILE NO.: ______________________
FILING FEE - $26.00
The following person(s) has/have abandoned the use of the FICTITIOUS BUSINESS NAME OF:
___________________________________________________________________________
(business name as it appears on the original statement)
Located at: ___________________________________________________________________________
(business address as it appears on the original statement)
The Fictitious Business Name Statement referred to above was filed on
_________________________
in the County of Tehama.
(Month, Day & Year)
Print or type the full name and residence of required person(s) specified on reverse side as it appears on the
original statement.*
1. _____________________________________
2. ______________________________________
(full name)
(full name)
_____________________________________
______________________________________
(address)
(address)
_____________________________________
______________________________________
(city/state/zip code)
(city/state/zip code)
3. _____________________________________
4. ______________________________________
(full name)
(full name)
_____________________________________
______________________________________
(address)
(address)
_____________________________________
______________________________________
(city/state/zip code)
(city/state/zip code)
**This business was conducted by: __________________________________________________
(type of ownership-individual, corporation, general partnership, etc
As it appears on the original statement)
Signed by: __________________________________________________
This statement was filed with the County Clerk & Recorder of Tehama County on the date indicated by the
file stamp above.
See reverse side for instructions
Z:\Forms\FBN Abandonment (Rev 12/2012)
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