FICTITIOUS BUSINESS NAME STATEMENT - …

1 I declare that all information in this STATEMENT is true and correct.(A registrant who declares as true information which he or she knows to be false is guilty of a crime.)NOTICE - THIS FICTITIOUS name STATEMENT EXPIRES FIVE YEARS FROM DATE IT WAS FILED IN THE OFFICE OF THE COUNTY CLERK. ANEW FICTITIOUS BUSINESS name STATEMENT MUST BE FILED PRIOR TO THAT filing of this STATEMENT does not of itself authorize theuse in this state of a FICTITIOUS BUSINESS name in violation of the rights of another under federal, state, or common law (See Section 14411 et seq.)

2 , Businessand Professions Code)PHILIP J. SCHMIT, Ventura County Clerk / RecorderHall of Administration8 0 0 South Victoria Avenue, Ventura, CA 93009-1210 PH: (805)654-3790 or (805)654-2263 FILING FEE: $ for 1 FBN and 1 registrantplus $ for each additional FBN/registrantRENEWAL FILING FEE IS SAME AS ABOVEThis STATEMENT was filed with the County Clerk of County on date indicated by file stamp BUSINESS name STATEMENTTHE FOLLOWING PERSON(S) IS (ARE) DOING BUSINESS AS.

3 (Attach additional pages if required)( ) The registrant commenced to transact BUSINESS under the FICTITIOUS BUSINESS name or names listed on (Date):( ) Registrant has not yet begun to transact BUSINESS under the FICTITIOUS BUSINESS name or names listed Return Mailing AddressName:Address:City:State:Zip Code:( ) an individual( ) a general partnership( ) joint venture( ) a BUSINESS trust( ) co-partners( ) husband and wife( ) a corporation( ) a limited partnership( ) an unincorporated association other than a partnership( ) a limited liability company( )This BUSINESS isconducted by.

4 (check one only)OtherStreet Address, City & State, Zip Code of Principal Place of BUSINESS in California ( Box or PMB address is not acceptable)Full name of Registrant / Corporation / Limited Liability Company (if corporation or Limited Liability Company - incorporated in what state)Residence Street Address ( Box not accepted) CityStateZip CodeFull name of Registrant / Corporation / Limited Liability Company (if corporation or Limited Liability Company - incorporated in what state)Residence Street Address ( Box not accepted) CityStateZip CodeFull name of Registrant / Corporation / Limited Liability Compan y (if corporation or Limited Liability Company - incorporated in what state)Residence Street Address ( Box not accepted)

5 CityStateZip CodeArticles of Incorporation or Organization Number / State (if applicable)AI #/ONFictitious BUSINESS name (s) 1. _____2. 4!First Filing!Renewal FilingCheck one onlySignaturetype/print nameCorporation name / Limited Liability CompanySignatureTitleType or Print NameSignaturetype/print nameSignaturetype/print nameSignaturetype/print nameSignature of Registrant(s)If Registrant is a CORPORATION or LLC, sign below12356 7 891011 INSTRUCTIONS FOR COMPLETION OF STATEMENT SECTION 17913 BUSINESS AND PROFESSIONS CODE Box 1.

6 Insert the name and address of the person who should receive the certified copy. Box 2. Check one box only Box 3. Insert the FICTITIOUS BUSINESS name or names. Only those businesses operated at the same address by same owners may be listed on one STATEMENT . Box 4. Insert Articles of Incorporation or Organization Number (if applicable) Box 5. If the registrant has a place of BUSINESS in this state, insert the street address of his or her principal place of BUSINESS in this state.

7 If the registrant has no place of BUSINESS in this state, insert the street address of his or her principal place outside this state and file with Clerk of Sacramento County. Mail Box and Post Office Box Numbers are not acceptable as BUSINESS addresses, when used alone, without a street address. Box 6, 7, 8. If the registrant is an individual, insert his or her full name and residence address. If the registrant is a partnership or other association of persons, insert the full name and residence address of each general partner.

8 (Attach additional sheets if necessary). If the registrant is a BUSINESS trust, insert the full name and residence address of each trustee. (Attach additional sheets if necessary). If registrant is a corporation, insert the name of the corporation as set forth in the articles of incorporation, the address of the corporate office, and indicate the state of incorporation. If registrant is a Limited Liability Co.

9 , insert the name of the Limited Liability Co. as set forth in its articles of organization. Mail Box and Post Office Box Numbers are not acceptable as addresses when used alone without a street address. Box 9 Indicate which of the terms best describes the nature of the BUSINESS . Signature MUST be that of an appropriate person, an individual, one of the general partners, a trustee or, if a corporation, an officer, if a Limited Liability Co.

10 , a manager or officer. Box 10 Check the appropriate box and insert the date on which registrant commenced to transact BUSINESS under the FICTITIOUS BUSINESS name or names listed, if already transacting BUSINESS under that name or names. If the registrant has not yet commenced to transact BUSINESS under the FICTITIOUS BUSINESS name or names listed, check appropriate box. Box 11 Please read before signing. Box 12 Signatures are required as follows unless the BUSINESS is Corporation / Limited Liability box 13.