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OFFICE OF THE ALPINE COUNTY CLERK COUNTY CLERKS FILING STAMP PO Box 158 99 Water Street Markleeville CA 96120 FILING FEE: $15.00 FOR FIRST BUSINESS NAME ON STATEMENT $4.00 FOR EACH ADDITIONAL BUSINESS NAME OR OWNER IN EXCESS OF ONE A MAIL FILED DOCUMENTS TO: NAME ADDRESS CITY/ST/ZIP DAYTIME PHONE ( ) 1 First Filing Renewal Filing With Changes B PUBLISH IN TAHOE DAILY TRIBUNE NEWSPAPER: Ph: [PHONE REDACTED] Current Registration No. FICTITIOUS BUSINESS NAME STATEMENT THE FOLLOWING PERSON(S) IS (ARE) DOING BUSINESS AS: 2 Fictitious Business Name(s) 3. 1. 2. Articles of Incorporation or Organization Number (if applicable) 3 Street Address, City & State of Principal Place of Business in California Zip Code 4 Full name of Registrant (if corporation or limited liability company-show state of incorporation or organization) Residence Street Address City State Zip Code 4A Full name of Registrant (if corporation or limited liability company-show state of incorporation or organization) Residence Street Address City State Zip Code 4B Full name of Registrant (if corporation or limited liability company-show state of incorporation or organization) Residence Street Address City State Zip Code 5 This Business is an individual joint venture a limited partnership an unincorporated association other Conducted by husband & wife a corporation a general partnership than a partnership (check only one) co-partners a business trust a limited liability company Registered Domestic Partner 6 The registrant commenced to transact business under the fictitious name or names listed above on (Date): Registrant has not yet begun to transact business under the fictitious business name or names listed herein. 7 If Registrant is not a corporation sign below: 7A If Registrant is a corporation or a limited liability company sign below: SIGNATURE TYPE OR PRINT NAME CORPORATION OR LIMITED LIABILITY COMPANY NAME SIGNATURE TYPE OR PRINT NAME SIGNATURE & TITLE SIGNATURE TYPE OR PRINT NAME CORPORATION OR LIMITED LIABILITY COMPANY NAME 8 This statement was filed with the County Clerk of Alpine County on (date indicated by file stamp above). NOTICE – THIS FICTITIOUS NAME STATEMENT EXPIRES FIVE I HEREBY CERTIFY THAT THIS COPY IS A CORRECT COPY OF THE ORIGINAL YEARS FROM THE DATE IT WAS FILED IN THE OFFICE OF THE STATEMENT ON FILE IN MY OFFICE COUNTY CLERK. A NEW FICTITIOUS BUSINESS NAME STATEMENT MUST BE FILED BEFORE THAT TIME. The filing of this statement does not of itself authorize the use in this state of a fictitious business name in COUNTY CLERK violation of the rights of another under federal, state, or common law (See BY_ Section 14400 et seq., Business and Professions Code.) DEPUTY File SEE REVERSE SIDE FOR INSTRUCTIONS 874984 SIGN SIGN SIGN SIGN ---PAGE BREAK--- INSTRUCTIONS FOR COMPLETIONS OF STATEMENT TYPE OR CAREFULLY PRINT IN INK (PENCIL NOT ACCEPTABLE) Box A. Insert the name and address of the person who you want to receive the certified copy. Box B. Newspaper designated for publishing. Box 1. If this is a new business please check the box marked First Filing. If you are refiling, please check the box marked Renewal Filing and enter your current registration number. If any changes in names, address, etc., check box With Changes. Box 2. Insert exact name of business. If you are registering more than one business located at the same address, number each name entered. If a business name or registrant’s name includes the words Corporation, Incorporated, Corp., or Inc., Alpine County requires a copy of the Article of Incorporation or an Affidavit signed under penalty of perjury by one of the officers of the Corporation. If a business name or a registrant’s name includes the words Limited Liability Company (whether using complete words or the abbreviations Ltd., and Co., or either of them), LLC or LC Alpine County requires either a copy of the Articles of Organization or an Affidavit signed under penalty of perjury by one of the officers or managers. Box 3. Insert street address of principal place of business (Post Office Boxes are not acceptable). Box 4. Registrants: list each owner or partner and his/her residence address separately (Post Office Boxes are not accepted). If the owner is a corporation, insert the name of the corporation and the business address. Do not list stockholders or officers of the Corporation. If a business name or a registrant’s name includes the word Corporation, Incorporated, Corp., or Inc., the County Clerk of Alpine County and some other counties require either a copy of the Articles of Incorporation or an Affidavit signed under penalty of perjury by one of the officers of the Corporation. If the owner is a Limited Liability Company, insert the name of the limited liability company and the business address. If a business name or a registrant’s name includes the words Limited Liability Company (whether using the complete words or the abbreviations Ltd., and Co., or either of them), LLC or LC, Alpine County and some other counties require either a copy of the Articles of Organization or an Affidavit signed under penalty or perjury by one of the officers or managers. Box 5. Check one item which best describes who is conducting the business. Box 6. Do not leave blank. Check proper line and enter date if line applies. Box 7. Signatures are required as follows: an individual – the individual; husband and wife – both husband and wife; partnership or other association of other persons – a general partner; a business trust – a trustee; co-partners – all partners; joint venture – all parties of the joint venture. Box 7A. Corporation – An officer must sign. State the title, attach a copy of the Articles of Incorporation or Affidavit signed under penalty of perjury by an officer; Limited Liability Company – An officer or manager must sign. State the title, attach a copy of the Articles of Organization or Affidavit signed under penalty of perjury by an officer or manager. Box 8. Insert name of county where statement is filed. SECTION 17900 As used in this chapter, “fictitious business name” means: In the case of an individual, a name that does not include the surname of the individual or a name that suggests the existence of additional owners. In the case of a partnership or other association of persons, other than a limited partnership which has filed a certificate of limited partnership with the Secretary of State pursuant to Section 15621 of the Corporations Code or a foreign limited partnership which has filed an application for registration with the Secretary of State pursuant to Section 15692 of the Corporations Code, a name that does not include the surname of each general partner or a name that suggests the existence of additional owners. In the case of a corporation, any name other than the corporate name stated in its articles of incorporation. In the case of a limited partnership which has filed a certificate of limited partnership with the Secretary of State pursuant to Section 15621 of the Corporations Code and in the case of a foreign limited partnership which has filed an application for registration with the Secretary of State pursuant to Section 15692 of the Corporations Code, any name other than the name of the limited partnership as on file with the Secretary of State. In the case of a limited liability company, any name other than the name stated in its Articles or Organization and in the case of a foreign limited liability company which has filed an application for registration with the Secretary of State pursuant to Section 17451 of the Corporations Code, any name other than the name of the limited liability company as on file with the Secretary of State. A name that suggests the existence of additional owners within the meaning of subdivision is one which includes such words as “Company,” Company,” Son,” Sons,” Associates,” “Brothers,” and the like, but not words that merely describe the business being conducted. SECTION 17910 Every person who regularly transacts business in this state for profit under a fictitious business name shall: File a fictitious business name statement in accordance with this chapter not later than 40 days from the time he commences to transact such business; and File a new statement in accordance with this chapter on or before the date of expiration of the statement on file. SECTION 17910.5 No person shall adopt any fictitious business name that includes “Corporation,” “Corp.,” “Incorporated,” or “Inc.” unless such person is a corporation organized pursuant to the laws of this state or some other jurisdiction. No person shall adopt any fictitious business name that includes “Limited Liability Company” (whether using the complete words or the abbreviations “Ltd.” And “Co.” or either of them) or “LLC” or “LC” unless such person is a limited liability company organized pursuant to the laws of this state or some other jurisdiction. A County Clerk shall not accept a fictitious business name statement which would be in violation of this section. SECTION 17917 Within 30 days after a fictitious business name statement has been filed pursuant to this chapter, the registrant shall cause a statement in the form prescribed by subdivision of Section 17913 to be published pursuant to Government Code 6064 (one per week for four successive weeks) in a newspaper of general circulation in the county in which the principal place of business of the registrant is located or, if there is no such newspaper in that county, then in a newspaper of general circulation in a adjoining county. If the registrant does not have a place of business in this state, the notice shall be published in a newspaper of general circulation in Sacramento County. Subject to the requirements of subdivision the newspaper selected for the publication of the statement should be one that circulates in the area where the business is to be conducted. Where a new statement is required because the prior statement has expired under subdivision of Section 17920, the new statement need not be published unless there has been a change in the information required in the expired statement. An affidavit showing the publication of the statement shall be filed with the county clerk within 30 days after the completion of the publication. SECTION 17920 – Expiration of Statement Unless the statement expires earlier under subdivision or a fictitious business name statement expires five years from the date it was filed in the office of the county clerk. Expect as provided in Section 17923, a fictitious business name statement expires 40 days after any changes in the facts set forth in the statement pursuant to Section 17913, expect that a change in the residence address of an individual, general partner, or trustee does not cause the statement to expire. A fictitious business name statement expires when the registrant files a statement of abandonment of the fictitious business name described in the statement. SECTION 17930 Any person who executes, files, or publishes any statement under this chapter, knowing that such statement is false, in whole or in part, shall be guilty of a misdemeanor and upon conviction thereof shall be punished by a fine not to exceed one thousand dollars ($1,000).