State of Rhode Island and Providence Plantations Department of State - Business Services Division Instructions for Filing Fictitious Business Name Statement Section 7-6-11 of the General Laws of Rhode Island, 1956, as amended The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant statutory provision. This form and the information provided are not substitutes for the advice and services of an attorney and/or tax specialist. This legal document should be typed. All illegible documents will be REJECTED. How to complete the form: 1. List the entity's ID number. The ID number can be found How to confirm your filing: Entity records are retrievable and viewable through our website. Successful filings will NOT result in a mailed confirmation. Filings that cannot be processed will be posted online and then returned. To confirm your submission and obtain evidence of your filing: · Go to our Corporate Database · Enter the name or ID number of your entity and click "Search" · Click on the link to your entity record, scroll down, select "All Filings" and then "View Filing" · Identify desired type of filing and click on "PDF" under "Files" to view and print the record · Filing rejections can be viewed here, via the Rejected Filings Viewer on our website. 2. 3. 4 5. 6. by looking up your entity in the Corporate Database. Please include this number on your check and refer to it in any future correspondence or filings with the Business Services Division. List the name of the non-profit corporation. The entity name can be verified through our Corporate Database. If the corporate name has changed an amendment, form 201 or form 251, must be filed with this office.Electronic filing may be available. List the fictitious business name the entity would like to use. Your fictitious business name must be distinguishable from any name on file in this office. You may check name availability on our website; however, this does not ensure the name will still be available upon filing. List the state or country of incorporation. Domestic entities MUST list the date of incorporation. Foreign entities MUST list the date of qualification in Rhode Island. The entity's date of incorporation/ qualification can be verified through our Corporate Database. An Authorized Person of the non-profit corporation MUST sign and date the form. How to maintain your status: The corporation is responsible for filing an annual report each calendar year, excluding the year of incorporation, between June 1 and June 30. A courtesy reminder will be mailed to the registered agent prior to June 1 of each year. Be sure to follow up with your registered agent concerning the filing of this report. Failure to file an annual report or maintain a registered agent/office may result in the revocation of the Articles of Incorporation/ Authority pursuant to RIGL 7-6-56 and 7-6-85. Your business may require additional licensing. Please visit our website for further information. How to pay the filing fee: The filing fee is $20, payable either in person via cash, credit card, or check at the Business Services Division, or by mail to the Business Services Division via check made payable to the R.I. Department of State. American LegalNet, Inc. www.FormsWorkFlow.com FORM 626 Non-Profit - Revised: 08/2016 State of Rhode Island and Providence Plantations Department of State - Business Services Division Fictitious Business Name Statement Filing Fee: $20.00 DOMESTIC or FOREIGN Non-Profit Corporation Pursuant to the provisions of RIGL 7-6-11 the undersigned non-profit corporation hereby submits the following statement for authority to transact business in the state of Rhode Island under a fictitious business name: 1. Entity ID Number 2. Exact Name of the Corporation STAMP FOR SECRETARY OF STATE USE ONLY 3. The fictitious business name to be used is: 4. The corporation is organized under the laws of: 5. The date of incorporation is: Under penalty of perjury, I declare and affirm that I have examined this Fictitious Business Name Statement and that the information contained herein is true and correct. Name of Applicant Non-Profit Corporation Title of Authorized Person Date Signature of Authorized Person SIGN DOCUMENT HERE MAIL TO: Division of Business Services 148 W. River Street, Providence, Rhode Island 02904-2615 Phone: (401) 222-3040 Website: www.sos.ri.gov STAMP FOR SECRETARY OF STATE USE ONLY If you have any questions, please call us at (401) 222-3040, Monday through Friday, between 8:30 a.m. and 4:30 p.m., or email corporations@sos.ri.gov. American LegalNet, Inc. www.FormsWorkFlow.com FORM 626 Non-Profit - Revised: 08/2016 State of Rhode Island and Providence Plantations Department of State - Business Services Division Filer Contact Information In the event our office needs more information in order to complete the filing of this document, we ask for the filer's contact information. All fields are REQUIRED. Name: Entity Name: Street Address: City: Email Address: State: Date: Zip Code: Phone Number: If you have any questions, please call us at (401) 222-3040, Monday through Friday, between 8:30 a.m. and 4:30 p.m., or email corporations@sos.ri.gov. American LegalNet, Inc. www.FormsWorkFlow.com FORM 626 Non-Profit - Revised: 08/2016