File or Mail forms and $17.00 fee Brandi L. Orth Fresno County Clerk 2221 Kern Street Fresno, CA 93721 Phone: (559) 6002575 (Space Below for Use by County Clerk Only) STATEMENT OF ABANDONMENT FROM USE OF FICTITIOUS BUSINESS NAME The following person(s) has(have) abandoned the use of the following fictitious business name(s) of: Name of business: 1. ____________________________________________________________________________________ At business address: 2. ____________________________________________________________________________________ The fictitious business name referred to above was filed in the office of Brandi L. Orth, Fresno County Clerk on ______________ DATE The full name of the person abandoning the use of the listed fictitious business name is: 3. ______________________________________________________________________________________________________ Residence Address: STREET ADDRESS CITY STATE ZIP ______________________________________________ ________________________ ___ ________ The full name of the person abandoning the use of the listed fictitious business name is: 4. ______________________________________________________________________________________________________ Residence Address: STREET ADDRESS CITY STATE ZIP ______________________________________________ __________________ _________ ____ ________ Signed: _________________________________________________________________________________________ Signed: _________________________________________________________________________________________ "I declare that all information in this statement is true and correct". (A registrant who declares as true information which he or she knows to be false is guilty of crime.) 5. This statement was filed pursuant to Section 17919 of the Business and Profession Code. This abandonment was filed with the Fresno County Clerk on ______________________________ DATE NOTICE PURSUANT TO SECTION 17924 OF THE BUSINESS AND PROFESSIONS CODE This statement of abandonment of use of fictitious business name must be published in a newspaper once a week for four successive weeks. The first publication date must be within thirty (30) days from date of filing and an affidavit of publication filed with the County Clerk within 30 days after publication has been accomplished. The statement should be published in a newspaper of general circulation in the county where the principal place of business is located. The statement should be published in such county in a newspaper that circulates in the area where the business was conducted. (Section 17917 Business and Professions Code) Any person who executes, files or published any statement under Chapter 5 (commencing with Section 17900), part 3 of Division 7 of the Business and Professions Code, knowing that such statement is false, in whole or in part, shall be guilty of a misdemeanor and upon conviction thereof, shall be punished by a fine not to exceed five hundred dollars($500) (Section 17930 Business and Professions Code) American LegalNet, Inc. www.FormsWorkFlow.com