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Application for Registration of Fictitious Name

Fictitious Proper noun to be Registered
FEI/EIN Number	- (Optional)
Email Address

Your acknowledgement letter of the alphabet, certification requests, and all hereafter notices will exist sent to this email address.

Certificate of Condition	$10.00 (Optional)	What is a certificate of condition?
Certified Copy	$thirty.00 (Optional)	What is a certified re-create?

Mailing Address of Business
Mailing Address of Business organization	(Electric current)
Address Line 2
City, Country	,
Zip Code
Florida County of Master Place of Business

Owner Name And Address

Proper name And Address #ane
List only one private or concern entity name

Possessor of Fictitious Proper name If An Individual:

,	,
Last	Beginning	Eye

- OR -

Owner of Fictitious Proper noun If a Business Entity
(Corporation, LLC, etc.):

Entity Name

Florida Document Number:

(But applies to business entity owners)

FEI/EIN Number:

- (Simply applies to business entity owners)

FEI/EIN Number Condition:

Applied For Not Applicable Current

Street Address

City, Land

Zip Code & Country

Name And Address #2
Listing but one individual or business entity name

Owner of Fictitious Name If An Individual:

,	,
Last	First	Heart

- OR -

Owner of Fictitious Proper noun If a Business Entity
(Corporation, LLC, etc.):

Entity Name

Florida Certificate Number:

(Only applies to business concern entity owners)

FEI/EIN Number:

- (Only applies to business organization entity owners)

FEI/EIN Number Status:

Applied For Not Applicable Current

Street Address

City, State

Cipher Code & State

Name And Address #three
List only i individual or business organization entity name

Owner of Fictitious Name If An Individual:

,	,
Last	First	Centre

- OR -

Owner of Fictitious Name If a Business Entity
(Corporation, LLC, etc.):

Entity Name

Florida Document Number:

(Only applies to business entity owners)

FEI/EIN Number:

- (Only applies to business entity owners)

FEI/EIN Number Status:

Applied For Not Applicable Current

Street Address

Urban center, Land

Goose egg Code & Country

Proper name And Address #4
Listing just one private or business entity name

Owner of Fictitious Name If An Private:

,	,
Terminal	First	Middle

- OR -

Possessor of Fictitious Name If a Business concern Entity
(Corporation, LLC, etc.):

Entity Proper noun

Florida Document Number:

(Only applies to business entity owners)

FEI/EIN Number:

- (But applies to business entity owners)

FEI/EIN Number Status:

Applied For Not Applicable Current

Street Address

Metropolis, Land

Nada Code & Country

Proper name And Address #v
List only ane individual or business entity name

Owner of Fictitious Name If An Private:

,	,
Last	Offset	Middle

- OR -

Owner of Fictitious Proper name If a Business Entity
(Corporation, LLC, etc.):

Entity Name

Florida Certificate Number:

(Only applies to business entity owners)

FEI/EIN Number:

- (But applies to business entity owners)

FEI/EIN Number Status:

Applied For Non Applicable Current

Street Address

City, State

Zip Code & Land

Please review the filing for accuracy. If you need to make corrections, do so at this time. The filing information will be added/edited exactly every bit y'all take entered it. In one case you have submitted the information, your filing cannot be updated, removed, cancelled or refunded.

I the undersigned, being an owner in the above fictitious name, certify that the data indicated on this class is true and accurate. I further certify that the fictitious name to be registered has been advertised at to the lowest degree in one case in a newspaper every bit defined in affiliate 50, F.S., in the county where the principal place of business is located. I understand that the electronic signature below shall have the aforementioned legal effect equally if made under oath and I am aware that faux information submitted in a certificate to the Department of State constitutes a tertiary caste felony as provided for in southward. 817.155, F.South.
Possessor Signature
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