FICTITIOUS BUSINESS NAME: ADDITIONAL INFORMATION FORM Additional Business Names (as shown in the Articles of Inc./Org./Reg.) Franchise No. (if applicable) County of Principal Place of Business Enter Star t Date or N/A if not yet started ( 2 ) ( 3 ) ( 4 ) ( 5 ) ( 6 ) ( 7 ) ADDITIONAL REGISTRANTS * If a corp., LLC, etc., enter complete name , state of incorporation/organization/registration and registration number ( 3 ) Name of Individual Registrant (First name) (Middle initial only ) (Last name) ( 3 ) Name of corporation or limited liability company as shown in the Articles of Inc/Org /Reg State of Inc./Org . /Reg. Inc./Org . /Reg. No. (3) Residence Street Address (Mailing address is NOT acceptable) City State Zip Code ( 4 ) Name of Individual Registrant (First name) (Middle initial only ) (Last name) ( 4 ) Name of corporation or limited liability company as shown in the Articles of Inc/Org /Reg State of Inc./Org . /Reg. Inc./Org . /Reg. No. (4) Residence Street Address (Mailing address is NOT acceptable) City State Zip Code ( 5 ) Name of Individual Registrant (First name) (Middle initial only ) (Last name) ( 5 ) Name of corporation or limited liability company as shown in the Articles of Inc/Org /Reg State of Inc./Org . /Reg. Inc ./Org . /Reg. No. (5) Residence Street Address (Mailing address is NOT acceptable) City State Zip Code ( 6 ) Name of Individual Registrant (First name) (Middle initial only ) (Last name) ( 6 ) Name of corporation or limited liability company as shown in the Articles of Inc/Org /Reg State of Inc./Org . /Reg. Inc./Org . /Reg. No. (6) Residence Street Address (Mailing address is NOT acceptable) City State Zip Code Signature is required on Page 1 and any additional pages BY SIGNING BELOW, I DECLARE THAT ALL INFORMATION IN THIS STATEMENT IS TRUE AND CORRECT. A registrant who declares as true any material matter pursuant to Section 17913 of the Business and Professions Code that the registrant knows to be false is guilty of a misdemeanor punishable by a fine not to exceed one thousand dollars ($1,000). Printed Name Tit le (if applicable) Signature Date San Bernardino County Recorder - Clerk 222 W. Hospitality Lane, 1 st Floor, San Bernardino CA 92415 - 0022 ( 855 ) REC - CLRK www.sbcounty.gov/arc Rev. 1//1 American LegalNet, Inc. www.FormsWorkFlow.com