Fill and Sign the California Fictitious Business Name Statement Form

FICTITIOUS BUSINESS NAME STATEMENT (Cal. Bus. and Prof. Code Section 17900 -17930) Instructions: A. Complete the Fictitious Business Name Statement 1. Insert the fictitious business name or names. Only those businesses operated at the same address may be listed on one statement. 2. If the registrant has a place of business in this state, insert the st reet address of his or her principal place of business in this state. If the registrant has no place of business in this state, insert the street address of his or her principal place of business outside this state. 3. If the registrant is an individual , insert his or her full name and residence address. If the registrant is a partnership or other association of persons, insert the full name and residence address of each general partner. If the registrant is a limited liability company, insert the name of the limited liability company as set out in its articles of organization and the state of organization. If the registrant is a business trust, insert the full name and address of each trustee. If the registrant is a corporation, insert the name of t he corporation as set out in its articles of incorporation and the state of incorporation. 4. Insert whichever of the following best describes the nature of the business: (a.) Individual; (b.) General Partnership; (c.) Limited Partnership; (d.) Li mited Liability ; (e) An Unincorporated Association other than a partnership; (e) A corporation; (f) A Business Trust; (g) Co -partners; (h) Husband and Wife; (i) Joint Venture; (j) Other, please specify _______ 5. Insert the date on which the re gistrant first commenced to transact business under the fictitious business name or names listed, if already transacting business under that name or names. If the registrant has not yet commenced to transact business under the fictitious business name or names listed, insert the statement, "Not applicable." 6. If the registrant is an individual, the statement shall be signed by the individual; if a partnership or other association of persons, by a general partner; if a limited liability company, by a mana ger or officer; if a business trust, by a trustee; if a corporation, by an officer. B. Filing the Fictitious Business Name Statement 1. The fictitious business name statement shall be filed with the clerk of the county in which the registrant has his pr incipal place of business in this state or, if he has no place of business in this state, with the Clerk of Sacramento County. 2. Filing requires taking the original of the statement and at least one copy to the Office of the County Clerk and pay a fili ng fee. The county clerk will note on the copy the file number, the date of filing the original, and the date of expiration and return it to the registrant. C. Publishing Notice 1. Within a period of 30 days after the fictitious business name statement has been filed, the registrant must publish a “statement” as notice in the same form as the Fictitious Business Name Statement once a week for four successive weeks. The requirement i s four publications in a newspaper regularly published once a week or oftener, with at least five days intervening between the respective publication dates not counting such publication dates. The period of notice commences with the first day of publicati on and terminates at the end of the twenty -eighth day, counting the first day. 2. The notice must be published in a newspaper of general circulation in the county in which the principal place of business of the registrant is located or, if there is no suc h newspaper in that county, then in a newspaper of general circulation in an adjoining county. If the registrant does not have a place of business in this state, the notice must be published in a newspaper of general circulation in Sacramento County. 3. An affidavit showing the publication of the statement shall be filed with the county clerk within 30 days after the completion of the publication. FICTITIOUS BUSINESS NAME STATEMENT (Cal. Bus. and Prof. Code Section 17900 -17930) 1. The following pers on (persons) is (are) doing business as: _______________________________________________________ At: _____________________________________________ _____________________________________________ _____________________________________________ _______________ ______________________________ 3. The following individual(s) or entities are doing business under the fictitious business name at the above location: (print or type) _____________________________________________ __________________________________________ ___ _____________________________________________ _____________________________________________ 4. This business is conducted by _______________________________. The registrant commenced to transact business under the fictitious business name or names listed above on the _____ day of ___________________, 20 ____ Signed _____________________________________ Statement filed with the County Clerk of _____________________ County on the ____ _ Day of ________________, 20 ______. NOTICE THIS FICTITIOUS NAME STATEMENT EXPIRES FIVE YEARS FROM THE DATE IT WAS FILED IN THE OFFICE OF THE COUNTY CLERK. A NEW FICTITIOUS BUSINESS NAME STATEMENT MUST BE FILED BEFORE THAT TIME. 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 14400 ET SEQ., BUSINESS AND PROFESSIONS CODE). STATE OF CALIFORNIA COUNTY O F _____________________ AFFIDAVIT PERSONALLY APPEARED BEFORE ME, in the county aforesaid, _______________________________, who after being duly sworn, does state on his/her oath that the attached newspaper clipping represents publication of the Ficti tious Business Name Statement of (name of business) _________________________ once a week for four successive weeks in a newspaper regularly published once a week or oftener, with at least five days intervening between the respective publication dates not counting such publication dates as required by California Business and Professions Code Section 17917 and Government Code Section 6064. THIS, the _________ day of _________________________, 20____. ___________________________________ PETITIONER State of California County of ______________ On the _____ day of ______________________________, 20 ______ before me, ___________________________________________________, personally appeared ______________________________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the same. WITNESS my hand and official seal. Signature __________________________________ (Seal)