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IMPORTANT: DO NOT COMPLETE AND MAIL YOUR FFN (Clark County Nevada)

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U.S.A. forms for Clark County Nevada

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IMPORTANT: DO NOT COMPLETE AND MAIL YOUR FFN UNTIL YOU READ THE
FOLLOWING.
To avoid delays in processing or rejection of your FFN, you must:
➢ Complete the CORRECT form
o If registered with the Nevada Secretary of State as a SERIES LLC, you
must use our Series LLC FFN form and list the registered business as
the LLC Authorizing Creation of Series.
➢ REVIEW the form for correct spelling
o Did you cross anything out or use white out? If you did, complete a
new form as we cannot accept it.
➢ SIGN the form
o If more than one individual is signing the form as owners, all
individuals must be listed on the owner line.
➢ NOTARIZE the form (signed and stamped by a notary public)
o Ensure the Notary Public completes each line with the correct
information.
o If the Notary Public is using a jurat, the jurat must state what
document is being notarized.
o If an electronic notary is not commissioned in Nevada, additional
information must be provided on how we can verify the notarization.
➢ Submit the ORIGINAL form (copies not accepted)
➢ Include the correct PAYMENT ($25 per filing or $20 per termination)
* If you have any questions, call (702) 671-0600 before mailing your form *
Office of the Clark County Clerk Please Select One:
Lynn Marie Goya New Application
Renewal of existing Fictitious Firm Name
Certificate of Business: Fictitious Firm Name
Series LLC
Please Print or Type
The expiration date for such certificates shall expire after five years from the date of filing.
The undersigned does hereby certify that they are conducting business in Clark County, Nevada, under the
Fictitious Firm Name: ______________________________________________________________________________
Mailing Address: __________________________________________________________________________________
(Mailing Address for notification of renewal) Mailing Address City, State, Zip
and that said firm is composed of the following series limited-liability company:
Name of Series LLC: _______________________________________________________________________________
LLC Authorizing
Creation of Series: _________________________________________________________________________________
(Must print name exactly as it is registered with the Nevada Secretary of State)
Street Address of
Authorizing LLC: __________________________________________________________________________________
Mailing Address
(If different): ______________________________________________________________________________________
Signed By: _________________________________________ _____________________________________________
Full Name of Authorized Signer Signature Date
By signing above, I declare (or affirm), under penalty of perjury, that all statements made in this document are
true, and that I have authority to sign on behalf of and to bind the above named business/legal entity to a contract.
For additional signatures, please use additional pages
STATE OF _________________________
SS:
COUNTY OF _______________________
This instrument was acknowledged before me on _____________________________________________________________
(Date)
by __________________________________________________________________________________________________
(Name of individual whose signature is being notarized)
__________________________________________________
Signature of Notary Public/Deputy Clerk
Mail to: Clark County Clerk’s Office, Attn. FFN, Box 551604, Las Vegas NV 89155-1604
Include: Filing Fee of $25.00 payable to County Clerk, completed certificate and a self-addressed stamped envelope. Rev 01/2021
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IMPORTANT: DO NOT COMPLETE AND MAIL YOUR FFN (Clark County Nevada)

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Completed 20 November 2021

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