Mailing Address/Mail Statement to: OFFICE USE ONLY Name: Mailing Address: City, State & Zip Code: Phone N umber: E - Mail: Expires: New Filing FICTITIOUS BUSINESS NAME STATEMENT The following person (persons) is (are) doing business as :* Street Address (No PO Box y or PMB)** City State Zip Code County REGISTRANT NAME & ADDRESS REGISTRANT NAME & ADDRESS *** *** Street Address y or PMB) City, State & Zip Code City, State & Zip Code REGISTRANT NAME & ADDRESS REGISTRANT NAME & ADDRESS Trustee): *** *** City, State & Zip Code City, State & Zip Code A A Limited Liability Company, State of LLC: A Married Couple A Limited Partnership Copartners A Trust Joint Venture a partnership :***** ) only ) NOTICE 227 CERTIFICATION JANELLE K. HORNE, COUNTY RECORDER-CLERK BY: Newspaper American LegalNet, Inc. www.FormsWorkFlow.com Statement requirements of this form as sert the street organization on file with the Califo set out in or an th223an porated (5) the nt has not nt ADDITIONAL REQUIREMENTS titious business name statement, the registrant filing on behalf of the registrant shall present personal to adequately determine uire the per of general MOUNTAIN DEMOCRAT GEORGETOWN GAZETTE & TOWN CRIER TAHOE DAILY TRIBUNE - - - Mail Statement to El Dorado County Recorder - Clerk Filing Fees: Phone: - - st Business Name - additional business name or owner American LegalNet, Inc. www.FormsWorkFlow.com