Affidavit Of Identity - Fictitious Business Name Statement - Los Angeles County printable pdf download

Affidavit Of Identity - Fictitious Business Name Statement - Los Angeles County

DEAN C. LOGAN

Registrar-Recorder/County Clerk

AFFIDAVIT OF IDENTITY - FICTITIOUS BUSINESS NAME STATEMENT

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In accordance with Section 17913 of the California Business and Professions Code,

the following identifying information is required to file a Fictitious Business Name Statement.

Registrant Name

Name of Business

Registrant Address

Street Address

City

State

Zip Code

Registrant Signature

If the registrant is a corporation, a limited liability company, a limited partnership, or a limited liability partnership, the county

clerk will require evidence issued by the Secretary of State indicating the current existence and good standing of that business

entity.

***For Mail or Third Party Requests Only***

This certificate must be notarized by a Notary Public for all Mail and Third Party Submissions

A notary public or other officer completing this certificate verifies only the identity

of the individual who signed the document to which this certificate is attached, and

not the truthfulness, accuracy, or validity of that document.

STATE OF

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County of

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Subscribed and sworn to (or affirmed) before me on this ___ day of _ _ _ _ _ ,

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_ _ _ _ _ _ _ _ _ _ , proved to me on the basis of satisfactory evidence to be the person(s) vyho appeared

before me.

(Seal)

Signature

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Rev 20170125

Affidavit Of Identity - Fictitious Business Name Statement - Los Angeles County

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