San Bernardino County Recorder - Clerk 222 W. Hospitality Lane, 1st Floor San Bernardino CA 92415-0022 855 REC-CLRK www.sbcounty.gov/arc PUBLICATION IS REQUIRED IF FIRST TIME FILING, REFILING WITH CHANGES, OR FILING EXPIRED FICTITIOUS BUSINESS NAME STATEMENT First Filing NEW FILING - this is a: ABANDONMENT: County of Original Filing New Amended Filing Renewal Date of Original Filing File No. Fee $55.00 Includes one registrant (please make check payable to “County Clerk”) $10.00 ea. additional FBN name filed on same statement and operating at same location. $10.00 ea. additional registrant Please TYPE or PRINT legibly and firmly in DARK ink (no alterations). See reverse side for filing and publishing instructions. The determination whether or not publication is required by law is ENTIRELY THE RESPONSIBILITY OF THE REGISTRANT. Neither the County Clerk nor his deputies are permitted by law to give legal advice and/or assistance. THE FOLLOWING PERSON(S) IS (ARE) DOING BUSINESS AS: 2 LIST FICTITIOUS BUSINESS NAME BELOW (as shown in the Articles of Inc./Org./Reg. ) Franchise No. (if applicable) Street Address of Principal Place of Business (P.O. Box or PMB address NOT acceptable) 1 City State Zip Code Mailing Address (Optional) City State Zip Code (1) Name of Individual Registrant (First name) (Middle initial only) (Last name) (1) Name of corporation or limited liability company as shown in the Articles of Inc./Org./Reg. State of Inc./Org. / Reg. Residence Street Address/Corporation or LLC Street Address 3 County of Principal Place of Business City (2) Name of Individual Registrant (First name) Inc./Org./Reg. No. State Zip Code (Middle initial only) (Last name) (2) Name of corporation or limited liability company as shown in the Articles of Inc./Org./Reg. State of Inc./Org. / Reg. Residence Street Address/Corporation or LLC Street Address Inc./Org./Reg. No. City State Zip Code List any additional names on additional form (CHECK ONE ONLY) This business is/was conducted by (if corporation or limited liability company, registrant must include copy of “Articles of Incorporation”, “Articles of Organization” or “Articles of Registration”): 4 An Individual A Limited Liability Partnership Husband & Wife A General Partnership An Unincorporated Assoc. Other Than a Partnership State or Local Registered Domestic Partners A Limited Partnership A Corporation (include “Articles of Incorporation) Copartners A Joint Venture A Limited Liability Company 5 A Trust (CHECK ONE ONLY) enter date ONLY if first box is checked: Registrant commenced to transact business under the fictitious business name or names listed above on (do not enter a future date) Month Registrant has not yet begun to transact business under the fictitious business name or names listed herein. Day Year BY SIGNING BELOW, I DECLARE THAT I HAVE READ AND UNDERSTAND THE REVERSE SIDE OF THIS FORM AND THAT ALL INFORMATION IN THIS STATEMENT IS TRUE AND CORRECT. A registrant who declares as true information, which he or she knows to 6 be false, is guilty of a crime. (B&P Code 17913) I am also aware that all information on this statement becomes public record upon filing pursuant to the California Public Records Act (Government Code Sections 6250-6277). Sign below (see instructions on reverse for signature requirements): Print Name (as appears on this statement) of Registrant: Printed Name of Person Signing: By Signature: Print Title of Person Signing: Date: NOTICE--IN ACCORDANCE WITH SUBDIVISION (a) OF SECTION 17920, A FICTITIOUS NAME STATEMENT GENERALLY EXPIRES AT THE END OF FIVE YEARS FROM THE DATE ON WHICH IT WAS FILED IN THE OFFICE OF THE COUNTY CLERK, EXCEPT, AS PROVIDED IN SUBDIVISION (b) OF SECTION 17920, WHERE IT EXPIRES 40 DAYS AFTER ANY CHANGE IN THE FACTS SET FORTH IN THE STATEMENT PURSUANT TO SECTION 17913 OTHER THAN A CHANGE IN THE RESIDENCE ADDRESS OF A REGISTERED OWNER. A NEW FICTITIOUS BUSINESS NAME STATEMENT MUST BE FILED BEFORE THE EXPIRATION. 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 14411 ET SEQ., BUSINESS AND PROFESSIONS CODE. Rev. 07/19/12 American LegalNet, Inc. www.FormsWorkFlow.com PURPOSE OF FILING - B&P CODE 17900(a)(1) To make available to the public the identities of those persons doing business under the fictitious name. REQUIREMENTS FOR FILING THE FICTITIOUS BUSINESS NAME (FBN) STATEMENT - B&P CODE 17910, 17915, 17920 Every person who regularly transacts business in this state for profit under a fictitious business name shall file a fictitious business name statement not later than 40 days from the time he commences to transact such business. The registrant shall file a new statement on or before the date of expiration of each FBN statement or after any change in the facts (except for a change of residence address). The statement shall be filed with the clerk of the county in which the principal place of business is located. If the principal place of business is outside the state, the statement shall be filed with the Clerk of Sacramento County. INSTRUCTIONS FOR COMPLETING THE STATEMENT - B&P CODE 17913 1. Insert the fictitious business name. If you want to file more than one business name, number each name and use the clerk’s "Additional Names Information” form to list additional names. Only those businesses operated at the same address and under the same ownership may be listed on one statement. • The name cannot include Corporation, Corp., Incorporated, or Inc., unless the registrant is a corporation. • The name cannot include the initials LLC, LC or the words limited liability company (whether using the complete words or the abbreviations Ltd. Or Co.), unless the registrant is a limited liability company registered with the State. • The name cannot include limited partnership or LP, unless the registrant is a limited partnership registered with the State. • The name cannot include registered limited liability partnership or RLLP, unless the registrant is a registered limited liability partnership registered with the State. • The name cannot include limited liability partnership or LLP, unless the registrant is a limited liability partnership registered with the State. If the name includes any of the above words, the registrant MUST submit a copy of the articles of incorporation/organization/registration. • The name cannot include college or university, unless the registrant is authorized pursuant to Education Code 94050. 2. Insert the street address of the principal place of business in this state. (Mailing addresses such as P.O. Box, private mailbox (PMB), postal drop box, mailing suite, or c/o addresses are not acceptable). If the registrant has no place of business in this state, insert the street address of the principal place of business outside this state; a statement must be filed with the Clerk of Sacramento County. Insert the mailing address, if applicable. A private mailbox address (e.g., Mail Boxes Etc.) MUST include the letters PMB and box number following the street name. 3. List the name of EACH registrant (owner/partner) and their current residence address. Use the clerk’s "Additional Names Information” form to list additional names of registrants: Individual : Insert name (first, middle initial, last) and current residence address* of the individual. Husband and Wife : Insert the name (first, middle initial, last) and residence address of both the husband and the wife. Partnership or other association of persons: Insert name (first, middle initial, last) and current residence address* of EACH general partner. Domestic Partners : Insert name (first, middle initial, last) and current address of EACH domestic partner. Corporation : Insert the name and address of the corporation as set out in the articles of incorporation on file with the California Secretary of State and the state of incorporation. Limited Liability Company : name and address of the limited liability company, as set out in its articles of organization on file with the California Secretary of State, and the state of organization. Trust , enter the name (first, middle initial, last) and current residence address* of EACH trustee. Note: System will only capture the middle initial in a name even if a complete middle name is submitted. * (Mailing addresses such as P.O. Box, PMB, postal drop box, mailing suite, and c/o addresses are not acceptable. 4. Indicate whichever best describes ownership of the business. 5. If the registrant(s) has/have already commenced to transact business under the fictitious business name, check the first box and enter the date the business transactions began. If the registrant(s) has/have not yet commenced to transact business under the fictitious business name, check the second box and do not enter a date. Our computer records for your FBN Statement, displaying the date the registrant commenced to transact business, will show “Not Applicable”. 6. Individual: The individual must sign. Husband and wife: husband or the wife may sign. Domestic partners: one of the domestic partners. Partnership, Joint Venture or other Association of persons: A general partner must sign. Trust: A trustee must sign. Corporation: A corporate officer must sign and indicate his/her title. (Signature of an agent or an assistant officer is not acceptable.) Limited Liability Company: An officer or manager must sign and indicate his/her title. (Signature of an agent is not acceptable.) REQUIREMENTS FOR PUBLISHING THE FICTITIOUS BUSINESS NAME (FBN) STATEMENT - B&P CODE 17917, 17920, 17924, GOV’T CODE 6064 Within 30 days after the fictitious business name statement has been filed with the county clerk, the statement must be published in a newspaper of general circulation in the county where the fictitious business name statement is filed. The newspaper selected should be one that circulates in the area where the business is to be conducted. The statement must be published once a week for four successive weeks with at least five days between each date of publication. An affidavit of publication must be filed with the county clerk where the fictitious business name statement was filed within 30 days after the completion of the publication. If a refiling is required because the prior statement has expired, the refiling need not be published unless there has been a change in the information required in the expired statement, provided the refiling is filed within 40 days of the date the statement expired. EXPIRATION OF FICTITIOUS BUSINESS NAME STATEMENT - B&P CODE 17920 (a) Unless the statement expires earlier under subdivision (b) or (c), a fictitious business name statement expires five years from the date it was filed in the office of the county clerk. (b) Except as provided in Section 17923, a fictitious business name statement expires 40 days after any change in the facts set forth in the statement pursuant to Section 17913, except that a change in the residence address of an individual, general partner, or trustee does not cause the statement to expire. (c) A fictitious business name statement expires when the registrant files a statement of abandonment of the fictitious business name described in the statement. STATEMENT OF ABANDONMENT - B&P CODE 17922 Upon ceasing to transact business in this state under a fictitious business name that was filed in the previous five years, a person who has filed a fictitious business name statement shall file a statement of abandonment of use of fictitious business name. The statement shall be executed in the same manner as a fictitious business name statement and shall be filed with the county clerk of the county in which the person has filed his or her fictitious business name statement. The statement shall be published in the same manner as a fictitious business name statement and an affidavit showing its publication shall be filed with the county clerk after the completion of publication. FILING FALSE STATEMENT - B&P CODE 17930 Any person who executes, files, or publishes any fictitious business name statement, knowing that such statement is false, in whole or in part, is guilty of a misdemeanor and upon conviction thereof shall be fined not to exceed one thousand dollars ($1000). PUBLIC RECORD – GOV’T. CODE SECTIONS 6250-6277 All Fictitious Business Name Statements filed with the County Clerk are public record pursuant to the California Public Records Act TRUSTEES, GUARDIANS, ADMINISTRATORS, ASSIGNEES AND PURCHASERS - B&P CODE 17919 Whenever failure to comply with this law would preclude taking legal action to recover monies due, a trustee in bankruptcy, an administrator of the estate, an assignee, or purchaser of the business may file the fictitious business name statement. American LegalNet, Inc. www.FormsWorkFlow.com