STEVE J. BESTOLARIDES County of San Joaquin Recorder - County Clerk 44 North San Joaquin Street, Suite 260 Stockton, CA 95202 (209) 468-3939 TYPE OR PRINT CLEARLY- MUST BE LEGIBLE. PLEASE READ INSTRUCTIONS ON REVERSE SIDE WHEN FILING BY MAIL, PROVIDE SELF ADDRESSED STAMPED ENVELOPE FEES $35 for first business name and owner on statement Add $6 for each additional owner or partner. Add $6 for each additional business name located at the same address Attach separate page for additional names Make checks or money order payable to San Joaquin County Recorder Original (First Filing) Refile (Change(s) in facts from previous filing) Refile (No Change(s) in facts from previous filing) Previous File # _______________ FICTITIOUS BUSINESS NAME STATEMENT The following person (persons) is (are) doing business as: FICTITIOUS BUSINESS NAME(S) * (If more than 2 names, attach additional sheet) Street Address of Principal Place of Business (P.O. Box not acceptable) City State Zip ** County of Place of Business Full Name of Registrant (IF REGISTRANT IS A CORPORATION, ENTER CORPORATION NAME) Full Name of Registrant (IF REGISTRANT IS A CORPORATION, ENTER CORPORATION NAME) Residence Street Address (P.O. Box not acceptable) Residence Street Address (P.O. Box not acceptable) *** City State Zip City State Zip (If corporation or LLC, print state of incorporation/organization) an individual a married couple co-partners a trust joint venture a corporation (If corporation or LLC, print state of incorporation/organization) an unincorporated association other than a partnership a limited liability partnership **** This Business is conducted by: (Check only one) a limited partnership a general partnership limited liability company State or Local Registered Domestic Partners ***** The registrant commenced to transact business under the fictitious business name or names listed above on _______________________ (Insert N/A above if you haven't started to transact business) 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 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 OF REGISTRANT _____________________________________________________ Print name of person signing. If corporation, also print corporate title of officer. If LLC, also print title of officer or manager. Registrant's Name _____________________________________ Officer's Title _________________________________________ (Please Print) (Please Print) THIS STATEMENT WAS FILED WITH THE RECORDER / COUNTY CLERK OF SAN JOAQUIN COUNTY ON THE DATE INDICATED BY THE FILE STAMP IN THE UPPER RIGHT CORNER 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). I HEREBY CERTIFY THAT THIS COPY IS A CORRECT COPY OF THE ORIGINAL STATEMENT ON FILE IN MY OFFICE. By, ____________________________________, Deputy County Clerk Steve J. Bestolarides, Recorder/County Clerk San Joaquin County Assessor/Recorder/County Clerk 277 (08/2015) Original- Recorder Yellow-Newspaper Pink - Customer American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETION OF STATEMENT Business and Professions Code Section 17913: * Where one asterisk appears in the form: (a) Insert the fictitious business name or names (b) Only those businesses operated at the same address and under the same ownership may be listed on one statement ** Where two asterisk appears in the form: (a) If the registrant has a place of business in this state, insert the street address and county of his or her principal place of business in this state (b) If the registrant has no place of business in this state, insert the street address and county of his or her principal place of business outside this state and file with the Clerk of Sacramento County (B&P 17915) (c) Mail Box and Post Office Box Numbers are not acceptable as a business address when used alone without a street address *** Where three asterisk appears in the form: (a) If the registrant is an individual, insert his or her full name and residence address (b) If the registrants are a married couple, insert the full name and residence address of both the parties to the marriage (c) If the registrant is a general partnership, co-partnership, joint venture, limited liability partnership, or unincorporated association other than a partnership, insert the full name and residence address of each general partner (d) If the registrant is a limited partnership, insert the full name and residence address of each general partner (e) If the registrant is a limited liability company, insert the name and address of the limited liability company, as set out in its articles of organization on file with the CA Secretary of State, and the state of organization (f) If the registrant is a trust, insert the full name and residence address of each trustee (g) If the registrant is a corporation, insert the name and address of the corporation, as set out in its articles of incorporation on file with the CA Secretary of State, and the state of incorporation (h) If the registrants are state or local registered domestic partners, insert the full name and residence address of each domestic partner **** Where four asterisk appears in the form: a) Check whichever of the terms listed on the front of the form that best describes the nature of the business. Corporations and limited liability companies must include state filed Articles of Incorporation. State Articles also required when re-filing Fictitious Business Name Statement. ***** Where five asterisk appears in the form: (a) Insert the date on which the registrant first commenced to transact business under the fictitiou