San Bernardino County Recorder - Clerk 222 W. Hospitality Lane, 1st Floor San Bernardino CA 92415-0022 855 REC-CLRK www.sbcounty.gov/arc FICTITIOUS BUSINESS NAME STATEMENT FILING ABANDONMENT: County of Current Filing Date of Current Filing File No. Fees: $55.00 Includes one registrant (please make check payable to 223County Clerk224) $10.00 Each additional FBN name filed on same statement and operating at same location $10.00 Each 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: 1 LIST FICTITIOUS BUSINESS NAME BELOW (as shown in the Articles of Inc./Org./Reg.) Franchise No. (if applicable) County of Principal Place of Business 2 Street Address of Principal Place of Business (P.O. Box or PMB address NOT acceptable) City State Zip Code Mailing Address (Optional) City State Zip Code 3 (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. Inc./Org./Reg. No. Residence Street Address/Corporation or LLC Street Address City State Zip Code (2) Name of Individual Registrant (First name) (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. Inc./Org./Reg. No. Residence Street Address/Corporation or LLC Street Address City State Zip Code 4 List any additional names on additional form (CHECK ONE ONLY) This business is/was conducted by: An Individual A General Partnership A Limited Partnership A Limited Liability Company A Limited Liability Partnership An Unincorporated Assoc. Other Than a Partnership A Corporation Copartners A Married Couple State or Local Registered Domestic Partners A Joint Venture A Trust 5 Registrant commenced to transact business under the fictitious business name or names listed above on (do not enter a future date). (If registrant has not yet commenced to transact business, insert the statement "Not applicable"). Month, Day, Year 6 BY SIGNING, 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). Signature: Printed Name of Person Signing: Printed 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. 0// American LegalNet, Inc. www.FormsWorkFlow.com PURPOSE OF FILING - BPC 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 - BPC 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 - BPC CODE 179131.Insert the fictitious business name. If you want to file more than one business name, number each name and use the clerk222s "Additional Names Information224form to list additional names. Only those businesses operated at the same address and under the same ownership may be listed on one statement.225 The name cannot include Corporation, Corp., Incorporated, or Inc., unless the corporation is registered with the California Secretary of State.225 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 California Secretary of State.225 The name cannot include limited partnership or LP, unless the registrant is a limited partnership registered with the California Secretary of State.225 The name cannot include registered limited liability partnership or RLLP, unless the registrant is a registered limited liability partnership registered with theCalifornia Secretary of State.225 The name cannot include limited liability partnership or LLP, unless the registrant is a limited liability partnership registered with the California Secretary ofState.225 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, mailingsuite, 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 ofbusiness 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 Information224 form to list additionalnames of registrants: Individual : Insert name (first, middle initial, last) and current residence address* of the individual. A Married Couple: Insert the name(first, middle initial, last) and residence address of both parties to the marriage. Partnership, joint venture, or other association of persons: Insert name (first,middle initial, last) and current residence address* of EACH general partner or person whose liability is substantially the same as that of a general partner.Domestic Partners : Insert name (first, middle initial, last) and current address of EACH domestic partner. Corporation : Insert the name and address of thecorporation 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 oforganization. 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, enter the date the business transactions began. If theregistrant(s) has/have not yet commenced