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OFFICE OF THE STANISLAUS COUNTY CLERK This space …

this space reserved for COUNTY CLERK FILE #_____ TYPE OF FILING (Check one) Original New Filing [Change(s) in facts from previous filing] Refile [No Change(s) in facts from previous filing] Previous file # _____ ID Mail OFFICE OF THE STANISLAUS COUNTY CLERK BOX 1670 1021 I Street, Suite 101 Modesto, CA 95353 (209) 525-5250 fictitious business name STATEMENT FILING FEE $ FOR FIRST business name ON STATEMENT $ FOR EACH ADDITIONAL business name FILED ON SAME STATEMENT AND DOING business AT THE SAME LOCATION $ FOR EACH ADDITIONAL OWNER IN EXCESS OF TWO OWNERS this space reserved for COUNTY CLERK The following person (persons) is (are) doing business as: *_____ Print fictitious business name (s) **_____|_____ Street address of principal place of business Mailing address if different _____ |_____ City State Zip COUNTY City State Zip ** REGISTERED OWNER(S): 1.

INSTRUCTIONS FOR COMPLETION OF STATEMENT. Business and Professions Code Section 17913: * Where one asterisk appears in the form: (a) Insert the fictitious business name or names

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