STATEMENT OF ABANDONMENT OF USE OF FICTITIOUS BUSINESS NAME SOLANO COUNTY CLERK 675 TEXAS STREET, SUITE 1900 FAIRFIELD, CA 94533 (707) 784-7510 CHARLES LOMELI FILING FEE IS $ 40.00 (Cash, Cashier's Check, Money Order or Debit Card) FILE NUMBER SEE REVERSE SIDE FOR INSTRUCTIONS The following person(s) has/have abandoned the use of the Fictitious Business Name(s): at Street Address City State Zip County The Fictitious Business Name referred to above was filed in Solano County on Date File Number ________________________. 1. Full name-type/print Residence Address City State Zip County 2. Full name-type/print Residence Address City State Zip County If Corporation or LLC ­ Print State of Incorporation/Organization If Corporation or LLC ­ Print State of Incorporation/Organization 3. Full name-type/print Residence Address City State Zip County 4. Full name-type/print Residence Address City State Zip County If Corporation or LLC ­ Print State of Incorporation/Organization If Corporation or LLC ­ Print State of Incorporation/Organization THIS BUSINESS IS CONDUCTED BY: (Check one) an Individual a General Partnership a Limited Partnership a Corporation a Limited Liability Company a Trust Copartners an Unincorporated Association other than a Partnership a Married Couple Joint Venture State or Local Registered Domestic Partners Limited Liability Partnership 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 a crime.) 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. This statement was filed with the County Clerk of Solano County on the date indicated by the filed stamp above. I HEREBY CERTIFY THAT THIS COPY IS A CORRECT COPY OF THE ORIGINAL STATEMENT ON FILE IN MY OFFICE CHARLES LOMELI, SOLANO COUNTY CLERK BY: _____________________________________. Deputy American LegalNet, Inc. www.FormsWorkFlow.com THE INSTRUCTIONS BELOW ARE NOT TO BE PUBLISHED (§17924 BUSINESS & PROFESSIONS CODE) INSTRUCTIONS FOR COMPLETION OF STATEMENT Section 17922 Business & Professions Code Upon ceasing to transact business in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. 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. The statement shall include: (1) The name being abandoned and the street address of the principal place of business (2) The date on which the fictitious business name statement relating to the fictitious business name being abandoned was filed, the file number, and the county were filed. (3) If the registrant is an individual, insert his or her full name and residence address. (4) If the registrants are husband and wife, insert the full name and residence address of both the husband and wife. (5) If the registrant is a general partnership, limited partnership, copartners, a limited liability partnership, a joint venture, or an unincorporated association other than a partnership, insert the full name and residence address of each general partner. (6) 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 California Secretary of State, and the state of incorporation. (7) If the registrant is a trust, insert the full name and residence address of each trustee. (8) 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 incorporation on file with the California Secretary of State, and the state of organization. (9) If the registrants are state or local registered domestic partners, insert the full name and residence address of each domestic partner. The statement shall be signed as follows: (a) If the registrant is an individual, by the individual (b) If the registrants are husband and wife, by the husband or wife (c) If the registrant is a general partnership, limited partnership, limited liability partnership, co-partnership, joint venture, or unincorporated association other than a partnership, by a general partner (d) If the registrant is a limited liability partnership, by a manager or officer (e) If the registrant is a trust, by a trustee (f) If the registrant is a corporation, by an officer (g) If the registrant is a state or local registered domestic partnership, by one of the domestic partners The Statement of Abandonment of fictitious business name must be published in a newspaper once a week for four successive weeks 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 is conducted (Business and Professions Code 17917). Section 17924 (2) "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 ($1,000)". Business and Professions Code 17930 Statement of Abandonment Revised 2008 American LegalNet, Inc. www.FormsWorkFlow.com