No changes, additions or corrections may be made to this statement once it has been filed with the county clerk Fictitious Business Name Statement - New & Renewal Yolo County Clerk/Recorder 625 Court Street, Room B-01, Woodland, CA 95695 PO Box 1130, Woodland, CA 95776-1130 (530) 666-8130 FEES: $55.00 First Business Name w/ 1 Owner $ 8.00 Each Add'l Owner or Business Name $ 5.00 Per Business Name Search $ 1.00 Return Postage (OR Include a Self Addressed Stamp Envelope) OFFICE Use ONLY PAYMENT METHODS: Checks, Money Order, (payable to Yolo County Clerk Recorder) Credit Cards Accepted (Credit Card charge Form at yolorecorder.org) NEW RENEWAL FBN #:_____________________________ FEE PAID:___________________ OLD FBN #________________________________ Business is located in _____________County. Fictitious Business Name(s) The registrant(s) is/are doing business as: ________________________________________________________________________________________________________ Please Print / Type ALL information: BLUE or BLACK INK ONLY SIGNATURES MUST BE ORIGINAL (Faxes Not Accepted) ___________________________________________________________________ ________________________________ ________________________________ Physical Business Address (required) Street Address, City, State and Zip of Principal Place of Business in California. _______________________________________ _____________________________________ Business Mailing Address (P.O. Box Acceptable) List Full Name(s) of Registrant(s) / Owner(s) & Physical Residence Address, State, and Zip (Corporation or LLC must use the address listed on the "Articles of Inc."). See number 3 on reverse side for detailed directions. #1___________________________________________________________________________ Registrant Name Registrant Name Physical Resident Address (NO PO BOX or PMB) Physical Resident Address (NO PO BOX or PMB) City City State State Zip Zip #2___________________________________________________________________________ Attach an extra sheet of paper showing for all additional registrant information Check one. Corporation** Trust Co-Partners Joint Venture Limited Liability Partnership **Corporations and L.L.C. MUST submit Articles of Corporation/L.L.C from the Secretary of State** Business Classification: Individual A Married Couple (two registrants) General Partnership Limited Partnership Unincorporated Association other than a Partnership Limited Liability Company** State or Local Registered Domestic Partners Starting Date of Business: ______________________________ (NOT in the Future. If business has not commenced put N/A) "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(s): _____________________________________________________________________________ Print Names of Above Signed: ______________________________________________________________________________ If applicable: Corporation/LLC Name: ___________________________________________ Official Title:__________________________________ 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 I hereby certify that this is a true copy of the original document on file in this office. This certification is true as long as there are no alterations to the document, AND as long as the document is sealed with a red seal. State of California County of Yolo Jesse Salinas, County Clerk/Recorder Date: __________________ by:______________________________________________ Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com (seal) this state of a fictitious name in violation of the right of another under federal, state, or common law. (Business & Professions Code, Section 14411) EFFECTIVE January 1, 2014 any Registrant/Agent appearing in person is required to present Driver's License or another form of government photo/I.D. acceptable by the Clerk's Office. B&P 1713(d) ALL OF THE INFORMATION CONTAINED ON THIS PAGE IS NOT CONSIDERED PART OF THE ORIGINAL DOCUMENT AND WILL NOT BE PUBLISHED - (Business & Professions (B&P) Code, Sec. 17917) Information will be kept confidential Driver Lic./ID Checked Name _____________________________________________________ Phone No. (_ Registrant OR Agent ______) ___________________________ REQUIREMENTS FOR FILING THE STATEMENT ­ (B&P Code, Sec. 17900-17930) Every person who regularly transacts business in this state for profit under a fictitious business name shall file a fictitious business name (FBN) statement not later than 40 days from the time the registrant commences to transact such business. The statement shall be filed in the county in which the principal place of business is located. If the principal place of business is outside this state, the statement shall be filed with the Clerk of Sacramento County. The registrant shall file a new statement on or before the date of expiration of each FBN statement. INSTRUCTIONS FOR COMPLETING THE STATEMENT - Type or Print LEGIBLY - (B&P Code, Sec. 17910.5, 17913, 17914) Black or Blue Ink Only We suggest you search our FBN index to see if this business names is currently being used. This may avoid conflict in the future. 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 B&P Code, Section 14411 et. seq.). Insert the fictitious business name or names. Only those businesses operated at the same street address and under the same ownership may be listed on one statement. If more than two names are listed, attach a sheet of paper to list additional names. Insert the street address and county of the principal place of business in this state. Business street address required! (P.O. Box acceptable only for a mailing address.) If the registrant has no place of business in this state, insert the street address and county of the