Office of the Clark County Clerk Please Select One: Lynn Marie Goya New Application Renewal of existing Fictitious Firm Name Certificate of Business: Fictitious Firm Name Please Print or Type The expiration date for such certificates shall expire after five years from the date of filing. The undersigned do/does hereby certify that they are conducting business in Clark County, Nevada, under the Fictitious Firm Name: Mailing Address: (Mailing Address for notification of renewal) Mailing Address City, State, Zip Owner (Sole Proprietor or Registered Legal Entity): (Must print name exactly as it is registered with the Nevada Secretary of State) and that said firm is composed of the following person(s) whose name(s) and address(es) are as follows: Signed By: Full Name of Authorized Signer Signature Date Street Address of Business or Residence City, State, Zip Signed By: (Use if needed) Full Name of Authorized Signer Signature Date Street Address of Business or Residence City, State, Zip By signing above, I declare (or affirm), under penalty of perjury, that all statements made in this document are true, and that I have authority to sign on behalf of and to bind the above named business/legal entity to a contract. For additional signatures, please use additional pages STATE OF SS: COUNTY OF This instrument was acknowledged before me on (Date) by (Name of individual(s) whose signature(s) is/are being notarized) Signature of Notary Public/Deputy Clerk Mail to: Lynn Marie Goya, County Clerk, Attn. FFN, Box 551604, Las Vegas NV 89155-1604 Include: Filing Fee of $20.00 payable to County Clerk, completed certificate and a self-addressed stamped envelope. Rev 11/2018 American LegalNet, Inc. www.FormsWorkFlow.com