YOUR RETURN MAILING ADDRESS NAME ADDRESS CITY STATE ZIP CODE LOS ANGELES REGISTRARRECORDER - PDF document

YOUR RETURN MAILING ADDRESS NAME: CITY: STATE: ZIP CODE: REGISTRAR-RECORDER/ COUNTY CLERK STATEMENT OF ABANDONMENT DATE FILED:___________________________________________ Name of Business(es)___ __ REGISTERED OWNER(S): I HEREBY CERTIFY THAT THIS COPY IS A CORRECT COPY OF THE ORIGINAL STATEMENT ON FILE IN MY OFFICE. DEAN C. LOGAN, LOS ANGELES COUNTY CLERK BY:__________________________________________, Deputy Rev. 01/13 INSTRUCTIONS FOR COMPLETION OF STATEMENT ate under a fictitious business name that was filed in the previous five years, a person who has itious business name. The stateexecuted in the same manner as a fictitiwith the county clerk of the county in winess name statement. The statement shall name statement and an affidavit showing its publication shall be filed with the county n. The statement (1) The name being abandoned and the street address (2) The date on which the fictitious busctitious business name being abandoned was filedfile number, and the county where filed. (3) If the registrant is an individual(4) If the registrants are a (5) If the registrant is a a limited liability partnership, a joint venture, or (6) If the registrant is a with the CA Secretary of State,(7) If the registrant is a (8) If the registrant is a ed liability company, as set out in its articles of organization on file with the CA Secretary of State, and t(9) If the registrants are The statement shall be signed as follows: (a) If the registrant is an individual, by (b) If the registrants are husband and wife, by the husband or wife (c) If the registrant is a general partnerited liability partnership, coa partnership, by a general partner (d) If the registrant is a limited liability company, by a manager or officer (e) If the registrant is a trust, by a trustee (f) If the registrant is a corporation, by an officer (g) If the registrant is a state orip, by one of the domestic partners The Statement of Abandonment of fictitious business name must be published in a newspaper once a week for four successive weeksan affidavit of publication filed with the county clerk within 30 days after publication has been accomplished. The statement published in a newspaper of general circulation in the county where is located. The statement published in such county in a newspaper that circulates in the area where the business is conducted (Business & Professions Cod17924 (2) "Any person who executes, file, or publishes any fictitious business name statement, knowialse, in whole or in part, is guilty of a misdemeanor and upon conviction thereof shall be fined not to exceed one thousand dollars ($1,000) ( INSTRUCTIONS FOR COMPLETION OF STATEMENT ate under a fictitious business name that was filed in the previous five years, a person who has itious business name. The stateexecuted in the same manner as a fictitiwith the county clerk of the county in winess name statement. The statement shall name statement and an affidavit showing its publication shall be filed with the county n. The statement (1) The name being abandoned and the street address (2) The date on which the fictitious busctitious business name being abandoned was filedfile number, and the county where filed. (3) If the registrant is an individual(4) If the registrants are a (5) If the registrant is a a limited liability partnership, a joint venture, or (6) If the registrant is a with the CA Secretary of State,(7) If the registrant is a (8) If the registrant is a ed liability company, as set out in its articles of organization on file with the CA Secretary of State, and t(9) If the registrants are The statement shall be signed as follows: (a) If the registrant is an individual, by (b) If the registrants are husband and wife, by the husband or wife (c) If the registrant is a general partnerited liability partnership, coa partnership, by a general partner (d) If the registrant is a limited liability company, by a manager or officer (e) If the registrant is a trust, by a trustee (f) If the registrant is a corporation, by an officer (g) If the registrant is a state orip, by one of the domestic partners The Statement of Abandonment of fictitious business name must be published in a newspaper once a week for four successive weeksan affidavit of publication filed with the county clerk within 30 days after publication has been accomplished. The statement published in a newspaper of general circulation in the county where is located. The statement published in such county in a newspaper that circulates in the area where the business is conducted (Business & Professions Cod17924 (2) "Any person who executes, file, or publishes any fictitious business name statement, knowialse, in whole or in part, is guilty of a misdemeanor and upon conviction thereof shall be fined not to exceed one thousand dollars ($1,000) ( YOUR RETURN MAILING ADDRESS NAME: CITY: STATE: ZIP CODE: REGISTRAR-RECORDER/ COUNTY CLERK STATEMENT OF ABANDONMENT OF USE OF FICTITIOUS BUSINESS NAME - FILING FEE $26.00 DATE FILED:___________________________________________ Name of Business(es)___ __ REGISTERED OWNER(S):1. __________________________________ 2. _________________________________ Full Name/Corp/LLC __________________________________ _________________________________ Residence Address __________________________________ _________________________________ City State Zip City State __________________________________ _________________________________ If Corporation or LLC – Print State of Incorporation/Organization If Corporation or LLC – Print State of Incorporation/Organiz3. __________________________________ 4. _________________________________ Full Name/Corp/LLC __________________________________ _________________________________ Residence Address __________________________________ _________________________________ City State Zip City State __________________________________ _________________________________ If Corporation or LLC – Print State of Incorporation/Organization If Corporation or LLC – Print State of Incorporation/Organiz ( ) ( ) ( ) ( ) a Limited Liability Company ( ) ( ) a ( ) a Trust ( ) ( ) ( ) State or Local Registered Domestic Partners ( ) a Limited Liability Partnership(A registrant who declares as true information which he or she knows to be false is guilty of a crime.) REGISTRANT (NAME/CORP/LLC NAME ______________________________TITLE:____________________________ REGISTRANT SIGNATURE__________________________________IF CORP OR LLC, PRINT NAME____________________so print title of officer or manager. I HEREBY CERTIFY THAT THIS COPY IS A CORRECT COPY OF THE ORIGINAL STATEMENT ON FILE IN MY OFFICE. DEAN C. LOGAN, LOS ANGELES COUNTY CLERK BY:__________________________________________, Deputy Rev. 01/13 Print Form Clear Form