Form CR4E003 "Application for Renewal of Fictitious Name" - Florida

What Is Form CR4E003?

This is a legal form that was released by the Florida Department of State (Secretary of State) - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2017;
  • The latest edition provided by the Florida Department of State (Secretary of State);
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CR4E003 by clicking the link below or browse more documents and templates provided by the Florida Department of State (Secretary of State).

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Download Form CR4E003 "Application for Renewal of Fictitious Name" - Florida

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FILE TO RENEW NOW:
FICTITIOUS NAME WILL EXPIRE ON 12/31
FLORIDA DEPARTMENT OF STATE
SECRETARY OF STATE
DIVISION OF CORPORATIONS
APPLICATION FOR RENEWAL OF FICTITIOUS NAME
REGISTRATION #
1.
Fictitious Name to be Renewed
Mailing Address of Business
City
State
Zip Code
CHECK HERE IF MAKING CHANGES
CR4E003 (7/17)
If above mailing address is incorrect in any way, line through incorrect information and enter correction in Block 2.
3. County of Principal
4. Date Registered
2. Mailing Address change if applicable:
Place of Business
Suite, Apt. #, etc.
5. Certificate of Status Desired
City
State
Zip Code
$10 Additional Fee Required
AN OWNER THAT IS A CORPORATION, LIMITED PARTNERSHIP OR OTHER BUSINESS ENTITY MUST BE REGISTERED
AND ACTIVE WITH THIS OFFICE.
6. CURRENT OW NER (S)
7. ADDITIONS / CHANGES TO OW NERS
DELETE
Change
Addition
DOCUMENT #
DOCUMENT #
FEI #
FEI #
NAME
NAME
STREET ADDRESS
STREET ADDRESS
CITY - ST- ZIP
CITY - ST- ZIP
DELETE
Change
Addition
DOCUMENT #
DOCUMENT #
FEI #
FEI #
NAME
NAME
STREET ADDRESS
STREET ADDRESS
CITY - ST- ZIP
CITY - ST- ZIP
DELETE
Change
Addition
DOCUMENT #
DOCUMENT #
FEI #
FEI #
NAME
NAME
STREET ADDRESS
STREET ADDRESS
CITY - ST- ZIP
CITY - ST- ZIP
DELETE
Change
Addition
DOCUMENT #
DOCUMENT #
FEI #
FEI #
NAME
NAME
STREET ADDRESS
STREET ADDRESS
CITY - ST- ZIP
CITY - ST- ZIP
8. I (we) the undersigned, being the sole (all the) party (ies) owning interest in the above fictitious name, certify that the information indicated on this form is
true and accurate. I (we) understand that the signature(s) below shall have the same legal effect as if made under oath. I further certify that the names of
individuals listed on this form do not qualify for an exemption contained in section 119, Florida Statutes. (At least one signature required). I am aware that
false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S.
Email address: (to be used for future renewal notification)
Signature of Owner
Date
FILE TO RENEW NOW:
FICTITIOUS NAME WILL EXPIRE ON 12/31
FLORIDA DEPARTMENT OF STATE
SECRETARY OF STATE
DIVISION OF CORPORATIONS
APPLICATION FOR RENEWAL OF FICTITIOUS NAME
REGISTRATION #
1.
Fictitious Name to be Renewed
Mailing Address of Business
City
State
Zip Code
CHECK HERE IF MAKING CHANGES
CR4E003 (7/17)
If above mailing address is incorrect in any way, line through incorrect information and enter correction in Block 2.
3. County of Principal
4. Date Registered
2. Mailing Address change if applicable:
Place of Business
Suite, Apt. #, etc.
5. Certificate of Status Desired
City
State
Zip Code
$10 Additional Fee Required
AN OWNER THAT IS A CORPORATION, LIMITED PARTNERSHIP OR OTHER BUSINESS ENTITY MUST BE REGISTERED
AND ACTIVE WITH THIS OFFICE.
6. CURRENT OW NER (S)
7. ADDITIONS / CHANGES TO OW NERS
DELETE
Change
Addition
DOCUMENT #
DOCUMENT #
FEI #
FEI #
NAME
NAME
STREET ADDRESS
STREET ADDRESS
CITY - ST- ZIP
CITY - ST- ZIP
DELETE
Change
Addition
DOCUMENT #
DOCUMENT #
FEI #
FEI #
NAME
NAME
STREET ADDRESS
STREET ADDRESS
CITY - ST- ZIP
CITY - ST- ZIP
DELETE
Change
Addition
DOCUMENT #
DOCUMENT #
FEI #
FEI #
NAME
NAME
STREET ADDRESS
STREET ADDRESS
CITY - ST- ZIP
CITY - ST- ZIP
DELETE
Change
Addition
DOCUMENT #
DOCUMENT #
FEI #
FEI #
NAME
NAME
STREET ADDRESS
STREET ADDRESS
CITY - ST- ZIP
CITY - ST- ZIP
8. I (we) the undersigned, being the sole (all the) party (ies) owning interest in the above fictitious name, certify that the information indicated on this form is
true and accurate. I (we) understand that the signature(s) below shall have the same legal effect as if made under oath. I further certify that the names of
individuals listed on this form do not qualify for an exemption contained in section 119, Florida Statutes. (At least one signature required). I am aware that
false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S.
Email address: (to be used for future renewal notification)
Signature of Owner
Date
MAKE CHECK PAYABLE TO DEPARTMENT OF STATE
FILING F E E $50.00
PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING
THE FORM. IF YOU NEED ASSISTANCE, PLEASE CALL (850)
245-6059.
INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR RENEWAL
Block 1. Print or Type the fictitious name, registration number, and mailing address of the business as it was originally Registered with this office. The name
of the business cannot be changed on the statement of renewal. A cancellation/re-registration must be filed. Please call (850) 245-6059 for the
appropriate form.
Note: Due to law change effective July 1, 2017, a fictitious name registration may not be renewed if the registered name contains a business
entity suffix or indicator (i.e. Corporation, Incorporated, Limited Liability Company, Limited Partnership, Professional Association, Corp., L.L.C.,
L.P., P.A., etc.) unless at least one registrant is a business entity of the same type duly incorporated, organized, formed, or otherwise authorized to
transact business in this state.
If registered fictitious name contains a business entity suffix or indicator, a cancellation and reregistration will need to be filed. The fee to file this
document is $50.00.
Block 2. If the mailing address printed in block 1 is incorrect, enter the correct mailing address in block 2. This address does NOT have to be the principal
place of business and can be directed to anyone’s attention. DO NOT USE AN ADDRESS THAT IS NOT YET OCCUPIED. ALL FUTURE MAILINGS
AND ANY CERTIFICATION REQUESTED ON THIS RENEWAL FORM WILL BE SENT TO THE ADDRESS IN BLOCK 1 OR AS CHANGED IN BLOCK
2. WE WILL NOT SEND CERTIFCATION TO ANY OTHER ADDRESS OR REDIRECT MAIL RETURNED TO THIS OFFICE.
Block 3. Type or Print the county of the principal place of business. “ M U L T I P L E ” may be used if more than one county was reported when original registration was
filed.
Block 4. Type or Print the date
filed in the office; if blank enter the correct file date, if known.
Block 5. Should you desire a certificate of status please check the box in block 5 and include an additional $10.00 with the filing fee. The certificate of status
will be sent to the address in block 1 or in block 2, if changed.
Block 6. Block 6 contains the Fictitious Name owner(s), their addresses, document number and Federal Employer Identification Number
(FEI) if applicable. If
there are additional owners, please list them on an attached sheet or in block 7 as additions. Do not make any changes in block 6 unless deleting an owner.
Owners listed that are not individuals must be registered and active with this office or provide documentation as to why they are not required to
register. Examples would be Federally Chartered Corporations or Legislatively created entities. NOTE: If the fictitious name indicated in block 1
contains the word(s) “corporation” or “incorporated”, or the abbreviation “corp.” or “Inc.”, the owner(s) must be a corporation registered or incorporated with
this state.
Block 7.
Block 7 is for changes or additions to the owners in block 6. Changes must be typed or printed in ink and legible. Owners that are not individuals must be
registered and active with this office or provide documentation as to why they are not required to register. Examples would be Federally Chartered
Corporations or Legislatively created entities. NOTE: If the fictitious name indicated in block 1 contains the word(s) “corporation” or “incorporated”, or
the abbreviation “corp.” or “Inc.”, the owner(s) must be a corporation registered or incorporated with this state.
Block
8. This renewal must be signed in block 8 with an original signature by at least one owner that is listed in block 6, block 7 if a change, or on an
attachment
ST
th
If this Application for Renewal of Fictitious Name is not filed on
or before December 31
of the 5
year of registration, the fictitious name
will be cancelled and removed from the records of the Department of State.
st
This renewal application must be post-marked by December 31
.
th
After the Application for Renewal is filed, effectiveness of the fictitious name registration is continued until December of the 5
year of registration.
MAILING ADDRESS:
Internet Address:
Courier Service Address:
Fictitious Name Renewal
www.sunbiz.org
Division of Corporations
Division of Corporations
Clifton Building
Post Office Box 6327
2661 Executive Center Circle
Tallahassee, Florida 32301
Tallahassee, Florida 32314
Phone Number: (850) 245-6059
Hearing/Voice Impaired may call (850) 245-6096 (TDD)
CR4E003 (7/17)
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