Application For Renewal Of Fictitious Name
Application For Renewal Of Fictitious Name Form. This is a Florida form and can be use in Fictitious Name Secretary Of State.
Tags: Application For Renewal Of Fictitious Name, CR4E003, Florida Secretary Of State, Fictitious Name
FILE TO RENEW NOW: FICTITIOUS NAME WILL EXPIRE ON 12/31/11 FLORIDA DEPARTMENT OF STATE SECRETARY OF STATE DIVISION OF CORPORATIONS APPLICATION FOR RENEWAL OF FICTITIOUS NAME REGISTRATION # 1. Name and Mailing Address ❏ CHECK HERE IF MAKING CHANGES CR4E003 (1/11) If above mailing address is incorrect in any way, line through incorrect information and enter correction in Block 2. 3. County of Principal Place of Business 2. Mailing Address change if applicable: 4. Date Registered Suite, Apt. #, etc. 5. Certificate of Status Desired City State ❏ $10 Additional Fee Required Zip Code AN OWNER THAT IS A CORPORATION, LIMITED PARTNERSHIP OR OTHER BUSINESS ENTITY MUST BE REGISTERED AND ACTIVE WITH THIS OFFICE. 6. CURRENT OWNER (S) ❏ DELETE DOCUMENT # 7. ADDITIONS / CHANGES TO OWNERS DOCUMENT # FEI # ❏ Change ❏ Addition ❏ Change ❏ Addition ❏ Change ❏ Addition NAME STREET ADDRESS ❏ Addition FEI # NAME ❏ Change STREET ADDRESS CITY - ST- ZIP CITY - ST- ZIP ❏ DELETE DOCUMENT # DOCUMENT # FEI # FEI # NAME NAME STREET ADDRESS STREET ADDRESS CITY - ST- ZIP CITY - ST- ZIP ❏ DELETE DOCUMENT # DOCUMENT # FEI # FEI # NAME NAME STREET ADDRESS STREET ADDRESS CITY - ST- ZIP CITY - ST- ZIP ❏ DOCUMENT # DELETE DOCUMENT # FEI # FEI # NAME NAME STREET ADDRESS STREET ADDRESS CITY - ST- ZIP CITY - ST- ZIP 8. I (we) the undersigned, being the sole (all the) party(ies) owning interest in the above fictitious name, certify that the information indicated on this form is true and accurate. I (we) understand that the signature(s) below shall have the same legal effect as if made under oath. I further certify that the names of individuals listed on this form do not qualify for an exemption contained in section 119, Florida Statutes. (At least one signature required). I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. Signature of Owner Date Email address: (to be used for future renewal notification) American LegalNet, Inc. www.FormsWorkFlow.com MAKE CHECK PAYABLE TO DEPARTMENT OF STATE FILING FEE $50.00 PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THE FORM. IF YOU NEED ASSISTANCE, PLEASE CALL (850) 245-6058. INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR RENEWAL Block 2. If the mailing address printed in block 1 is incorrect, enter the correct mailing address in block 2. This address does NOT have to be the principal place of business and can be directed to anyone’s attention. DO NOT USE AN ADDRESS THAT IS NOT YET OCCUPIED. ALL FUTURE MAILINGS AND ANY CERTIFICATION REQUESTED ON THIS RENEWAL FORM WILL BE SENT TO THE ADDRESS IN BLOCK 1 OR AS CHANGED IN BLOCK 2. WE WILL NOT SEND CERTIFICATION TO ANY OTHER ADDRESS OR REDIRECT MAIL RETURNED TO THIS OFFICE. Block 3. Block is preprinted with the county of the principal place of business. “MULTIPLE” may be preprinted if more than one county Bloc (FEI) if applicable. (Due to space limitations only four owners are printed.) If there are additional owners, please list them on an attached sheet or in block 7 as additions. Do not make any changes in block 6 unless deleting an owner. Owners listed that are indicated in block 1 contains the word(s) ”corporation” or “incorporated”, or the abbreviation “corp.” or “Inc.”, the owner(s) must be a corporation registered or incorporated with this state. Block 7. Block 7 is for changes or additions to the owners in block 6. Changes must be typed or printed in ink and legible. Owners that indicated in block 1 contains the word(s) “corporation” or “incorporated”, or the abbreviation “corp.” or “Inc.”, the owner(s) must be a corporation registered or incorporated with this state. Block 8. This renewal must be signed in block 8 with an original signature by at least one owner that is listed in block 6, block 7 if a change, or on an attachment. If this Application for Renewal of Fictitious Name is not filed on or before December 31, 2011 the fictitious name will be cancelled and removed from the records of the Department of State. This renewal application must be post-marked by Decemeber 31, 2011. After the Application for Renewal is filed, effectiveness of the fictitious name registration is continued until December 31, 2016. MAILING ADDRESS: Fictitious Name Renewal Division of Corporations Post Office Box 1300 Tallahassee, Florida 32302-1300 Internet Address: www.sunbiz.org Courier Service Address: Division of Corporations Clifton Building 2661 Executive Center Circle Tallahassee, Florida 32301 Phone Number: (850) 245-6058 Hearing/Voice Impaired may call (850) 245-6096 (TDD) CR4E003 (1/11)