NOTICE OF TRANSFER OF FICTITIOUS NAME
(Please type or print)
Fictitious Name Exactly as Filed
Arkansas Secretary of State
1401 W. Capitol, Suite 250, Little Rock, AR 72201
John Thurston
501-682-3409 • www.sos.arkansas.gov
The undersigned, pursuant to the laws of the State of Arkansas, hereby requests that the following fictitious name be transferred:
State:
Zip Code:
Street Address:
State:
Zip Code:
Transferor's Signature
Title, if Applicable
Transferring Entity:
New Entity Using the Name:
State of Arkansas
County of ________________________
Subscribed and sworn before me, a Notary Public,
On this _______ day of __________________, 20_____
My Commission Expires: _________________________ Notary Public: _______________________________________
{Seal}
Street Address:
City:
City:
This Transfer of Fictitious Name must be filed in conjunction with the
applicable Application for Fictitious Name.
AFFIDAVIT
I, the undersigned, being first duly sworn, state that I am the current user of the Fictitious Name being transferred or the lawfully authorized
representative of the current user, and that I have the authority to make this transfer. The information provided herein is true to the best of my
knowledge and is made with the intent to file with the Arkansas Secretary of State. I understand that knowingly signing a false document with the intent
to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.
Filing Fee: $25.00
NTF Rev. 09/19
