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Application For Registration Of Fictitious Name CR4E001 - Florida
| Application For Registration Of Fictitious Name Form. This is a Florida form and can be used in Fictitious Name Secretary Of State . |
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APPLICATION FOR REGISTRATION OF FICTITIOUS NAME Note: Acknowledgements/certificates will be sent to the address in Section 1 only. 1. ________________________________________ ________________________________________ Fictitious Name to be Registered (see instructions if name includes "Corp" or "Inc") ____________________________________________________________ Section 1 ____________________________________________________________ Mailing Address of Business ____________________________________________________________ City State Zip Code 3. Florida County of principal place of business: ______________ ____________________________________________________________ (see instructions if more than one county) FEI Number: ________________________________ This space for office use only A. Owner(s) of Fictitious Name If Individual(s): (Use an attachment if necessary): 1. ______________________________________ Last First M.I. 2. ______________________________________ Last First M.I. ______________________________________ Address ______________________________________ Address ______________________________________ City State Zip Code ______________________________________ City State Zip Code Section 2 B. Owner(s) of Fictitious Name If other than an individual: (Use attachment if necessary): 1. ______________________________________ Entity Name 2. ______________________________________ Entity Name ______________________________________ Address ______________________________________ Address ______________________________________ City State Zip Code ______________________________________ City State Zip Code Florida Document Number ______________ FEI Number: __________________________ Applied for Not Applicable Florida Document Number _______________ FEI Number: __________________________ Applied for Not Applicable Section 3 I the undersigned, being an owner in the above fictitious name, certify that the information indicated on this form is true and accurate. In accordance with Section 865.09, F.S., I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined in chapter 50, Florida Statutes, in the county where the principal place of business is located. I understand that the signature below shall have the same legal effect as if made under oath. __________________________________________ Signature of Owner Date __________________________________________ E-mail address: (to be used for future renewal notification) Phone Number: ____________________________ FOR CANCELLATION COMPLETE SECTION 4 ONLY: FOR FICTITIOUS NAME OR OWNERSHIP CHANGE COMPLETE SECTIONS 1 THROUGH 4: Section 4 I (we) the undersigned, hereby cancel the fictitious name ______________________________ ______________________, which was registered on ________________ and was assigned registration number ______________________ __________________________________________ Signature of Owner Date __________________________________________ Signature of Owner Date Mark the applicable boxes Certificate of Status -- $10 Certified Copy -- $30 NON-REFUNDABLE PROCESSING FEE: $50 American LegalNet, Inc. www.FormsWorkFlow.com Single CR4E001 (11/09) Instructions for Completing Application for Registration of Fictitious Name Section 1: Line 1: Enter the name as you wish it to be registered. A fictitious name may not contain the words "Corporation" or "Incorporated," or the abbreviations "Corp." or "Inc.," unless the person or business for which the name is registered is incorporated or has obtained a certificate of authority to transact business in this state pursuant to chapter 607 or chapter 617 Florida Statutes. Corporations are not required to file under their exact corporate name. Line 2: Enter the mailing address of the business. 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 REGISTRATION FORM WILL BE SENT TO THE ADDRESS IN SECTION 1. An address may be changed at any future date with no charge by simply writing the Division. Line 3: Enter the name of the county in Florida where the principal place of business of the fictitious name is located. If there is more than one county, list all applicable counties or state "multiple". Line 4: Enter the Federal Employer Identification (FEI) number if known or if applicable. Please do not enter your social security number. Section 2: Part A: Complete if the owner(s) of the fictitious name are individuals. The individual's name and address must be provided. Part B: Complete if the owner(s) are not individuals. Examples are a corporation, limited partnership, joint venture, general partnership, trusts, fictitious name, etc. Provide the name of the owner, their address, their document number as registered with the Division of Corporations, and the Federal Employer Identification (FEI) number. An FEI number must be provided or the appropriate box must be checked. Owners listed in Part B must be registered with the Division of Corporations or provide documentation as to why they are not required to register. Examples would be Federally Chartered Corporations, or Legislatively created entities. Additional owners may be listed on an attached page as long as all of the information requested in Part A or Part B is provided. Section 3: Only one signature is required. It is preferred that a daytime phone number be provided in order to contact the applicant if there are any questions about the application. Section 4: TO CANCEL A REGISTRATION ON FILE: Provide fictitious name, date filed, and registration number of the fictitious name to be cancelled. TO CHANGE OWNERSHIP OF A REGISTRATION: Complete section 4 to cancel the original registration. Complete sections 1 through 3 to re-register the fictitious name listing the new owner(s). An owner's signature is required in both sections 3 and 4. TO CHANGE THE NAME OF A REGISTRATION: Complete section 4 to cancel the original registration. Complete sections 1 through 3 to re-register the new fictitious name. An owner's signature is required in both sections 3 and 4. An acknowledgement letter will be mailed when the fictitious name registration has been filed. The acknowledgement letter and any certification requested will be mailed to the address provided in Section 1. For Cancellations Only: please provide a mailing address on an attachment, if th
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