I HEREBY CERTIFY THAT THIS IS A CORRECT COPY OF THE ORIGINAL STATEMENT ON FILE
IN MY OFFICE.
B
y __________________________________, Deputy
(1)
__________________________________________________________________________________________
(2)
__________________________________________________________________________________________
(3)
__________________________________________________________________________________________
(4)
__________________________________________________________________________________________
(5)
__________________________________________________________________________________________
ADDITIONAL BUSINESS NAME(S)
ADDITIONAL REGISTRANT NAME(S)
Name of Registrant First, Middle and Last for individual or name of Corp./LLC
__
_______________________________________________________________
Residence Address (if Corp. or LLC enter the physical address of Corp./LLC)
___________________________________________
City State Zip
___________________________________________
If Corp., or LLC, then identify state of incorporation or organization (must be
registered in CA).
Name of Registrant First, Middle and Last for individual or name of Corp./LLC
__
_______________________________________________________________
Residence Address (if Corp. or LLC enter the physical address of Corp./LLC)
___________________________________________
City State Zip
___________________________________________
If Corp., or LLC, then identify state of incorporation or organization (must be
registered in CA).
Name of Registrant First, Middle and Last for individual or name of Corp./LLC
__
_______________________________________________________________
Residence Address (if Corp. or LLC enter the physical address of Corp./LLC)
___________________________________________
City State Zip
___________________________________________
If Corp., or LLC, then identify state of incorporation or organization (must be
registered in CA).
Name of Registrant First, Middle and Last for individual or name of Corp./LLC
__
_______________________________________________________________
Residence Address (if Corp. or LLC enter the physical address of Corp./LLC)
___________________________________________
City State Zip
___________________________________________
If Corp., or LLC, then identify state of incorporation or organization (must be
registered in CA).
Name of Registrant First, Middle and Last for individual or name of Corp./LLC
__
_______________________________________________________________
Residence Address (if Corp. or LLC enter the physical address of Corp./LLC)
___________________________________________
City State Zip
___________________________________________
If Corp., or LLC, then identify state of incorporation or organization (must be
registered in CA).
PETER ALDANA
A
ssessor, County Clerk, Recorder
C
ounty
of Riverside
FICTITIOUS BUSINESS NAME
ADDITIONAL INFORMATION
(Business & Registrant names)
FBN/ABA
NDONMENT
FBN FILE NUMBER:
_______________________________
PLEA
SE TYPE OR PRINT LEGIBLY IN BLACK INK
Name of Registrant First, Middle and Last for individual or name of Corp./LLC
__
_______________________________________________________________
Residence Address (if Corp. or LLC enter the physical address of Corp./LLC)
___________________________________________
City State Zip
___________________________________________
If Corp., or LLC, then identify state of incorporation or organization (must be
registered in CA).
ACR 501 (Rev. 07/2014) Available in Alternate Formats