Carlos E. Sandoval

Application for Registration of Fictitious Name

Fictitious Name to be Registered
FEI/EIN Number	- (Optional)
Email Address
Your acknowledgement letter, certification requests, and all future notices will be sent to this email address.
Certificate of Status	$10.00 (Optional)
Certified Copy	$30.00 (Optional)
Mailing Address of Business
Mailing Address of Business	(Current)
Address Line 2
City, State	,
Zip Code
Florida County of Principal Place of Business
Owner Name And Address
Name And Address #1 List only one individual or business entity name
Owner of Fictitious Name If An Individual:	Last, First, Middle
- OR -
Owner of Fictitious Name If Other Than An Individual:	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
City, State	,
Zip Code & Country	,
Name And Address #2 List only one individual or business entity name
Owner of Fictitious Name If An Individual:	Last, First, Middle
- OR -
Owner of Fictitious Name If Other Than An Individual:	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
City, State	,
Zip Code & Country	,
Name And Address #3 List only one individual or business entity name
Owner of Fictitious Name If An Individual:	Last, First, Middle
- OR -
Owner of Fictitious Name If Other Than An Individual:
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
City, State	,
Zip Code & Country	,
Name And Address #4 List only one individual or business entity name
Owner of Fictitious Name If An Individual:	Last, First, Middle
- OR -
Owner of Fictitious Name If Other Than An Individual:
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
City, State	,
Zip Code & Country	,
Name And Address #5 List only one individual or business entity name
Owner of Fictitious Name If An Individual:	Last, First, Middle
- OR -
Owner of Fictitious Name If Other Than An Individual:
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
City, State	,
Zip Code & Country	,
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 as you have entered it. Once 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 information indicated on this form is true and accurate. I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined in chapter 50, Florida Statutes, in the county where the principal place of business is located. I understand that the electronic signature below shall have the same legal effect as if made under oath.
Owner Signature
If you press the 'Continue' button, the information on the screen will be processed and a new filing request will be initiated. If you used the browser 'BACK' button to get here, you should use the browser 'FORWARD' button to move to the next page.