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Select the Type of Filing: First Filing Renewal/Refile Renewal/Refile with Changes
Enter the Fictitious Business Name(s). If there is more than one name to enter, click on Add Another Name. Only those businesses operated at the same address by the same owners may be listed on one form: 1. 2. (Please note: If your business is not already a corporation, you cannot use the words “Corporation,” “Corp.,” “Incorporated,” or “Inc.” in the business name.)
Enter the principal place of business in California (PO Box or PMB address NOT acceptable): Street Address: City: State: AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA PW RI SC SD TN TX UT VA VT WA WI WY Zip: County: LOS ANGELES
Enter mailing address of business: Do you want to copy principal business address here? Street Address: City: State: AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA PW RI SC SD TN TX UT VA VT WA WI WY Zip:
Select one item which best describes who is conducting the business: an Individual a General Partnership Joint Venture a Business Trust Co-Partners Husband and Wife a Corporation a Limited Partnership an unincorporated association other than partnership a limited liability company Other State or Local Registered Domestic Partners a Limited Liability Partnership
Registrant/Owner 1: Is Registrant/Owner: an Individual OR a Company: Enter the full name and residence address of the individual: First: Middle: Last: Company Name: State of Corp./LLC/LLP/LP: Corp./LLC/LLP/LP Number: Name of Officer Signing form: Title of Officer: Do you want to copy principal business address here? Street Address: City: State: AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA PW RI SC SD TN TX UT VA VT WA WI WY Zip:
Registrant/Owner 2: Is Registrant/Owner: an Individual OR a Company: Enter the full name and residence address of the individual: First: Middle: Last: Company Name: State of Corp./LLC/LLP/LP: Corp./LLC/LLP/LP Number: Name of Officer Signing form: Title of Officer: Do you want to copy principal business address here? Street Address: City: State: AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA PW RI SC SD TN TX UT VA VT WA WI WY Zip:
Registrant/Owner 3: Is Registrant/Owner: an Individual OR a Company: Enter the full name and residence address of the individual: First: Middle: Last: Company Name: State of Corp./LLC/LLP/LP: Corp./LLC/LLP/LP Number: Name of Officer Signing form: Title of Officer: Do you want to copy principal business address here? Street Address: City: State: AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA PW RI SC SD TN TX UT VA VT WA WI WY Zip:
Registrant/Owner 4: Is Registrant/Owner: an Individual OR a Company: Enter the full name and residence address of the individual: First: Middle: Last: Company Name: State of Corp./LLC/LLP/LP: Corp./LLC/LLP/LP Number: Name of Officer Signing form: Title of Officer: Do you want to copy principal business address here? Street Address: City: State: AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA PW RI SC SD TN TX UT VA VT WA WI WY Zip:
Enter business start date information: The registrant commenced to transact business under this name on: (mm/dd/yyyy) The registrant has not yet begun to transact business under this name.
Enter your return mailing address: * Full Name: Do you want to copy principal business address here? Street Address: City: State: AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA PW RI SC SD TN TX UT VA VT WA WI WY Zip: * Daytime Phone Number: ( ) - * Email: *Required fields.