Form CR4E001 "Application for Registration of Fictitious Name" - Florida

This version of the form is not currently in use and is provided for reference only.
Download this version of Form CR4E001 for the current year.

What Is Form CR4E001?

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 November 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 CR4E001 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 CR4E001 "Application for Registration of Fictitious Name" - Florida

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APPLICATION FOR REGISTRATION OF FICTITIOUS NAME
Note: Acknowledgments/certificates will be sent to the address in Section 1 only.
____________________________________________________
1.
Fictitious Name to be Registered (see instructions for certain prohibited words, abbreviations and designations)
________________________________________________________________________________________________
2.
________________________________________________________________________________________________
Mailing Address of Business
___________________________________________
____________________________
_________________
City
State
Zip
3.
Florida County of principal place of business:
_________________________________________
_______________________________________________________________________________________________
(see instructions if more than one county)
4.
FEI Number of Business:
_________________________________________________
This space for office use only
A. Registrant if individual(s): (Use an attachment if necessary):
1.
____________________ ____________________ _____ 2. ____________________ ____________________ _____
Last
First
M.I.
Last
First
M.I.
_____________________________________________________________________
_____________________________________________________________________
Address
Address
___________________________________ ___________________ _____________
___________________________________ ___________________ _____________
City
State
Zip
City
State
Zip
B. Registrant if other than an individual(s): (Use an attachment if necessary):
______________________________________________
2. ______________________________________________
Entity Name
Entity Name
_____________________________________________________________________
_____________________________________________________________________
Address
Address
___________________________________ ___________________ _____________
___________________________________ ___________________ _____________
City
State
Zip
City
State
Zip
Florida Document Number: _______________________
Florida Document Number: _______________________
FEI Number: ____________________________
FEI Number: ____________________________
Applied for
Not Applicable
Applied for
Not Applicable
I the undersigned, being a registrant for the above fictitious name, certify that the information indicated on this form is true and
accurate. In accordance with Section 865.09, F.S., I further certify that the intention to register 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 in which the principal
place of business of the registrant is or will be located. I understand that the signature below shall have the same legal effect as if
made under oath and 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.
________________________________________________________ ________________
___________________________________________________________________________
Signature of Registrant in Section 2
Date
Email address: (to be used for future renewal notifications)
FOR
CANCELLATIONS,
COMPLETE THIS SECTION 4 ONLY:
FOR FICTITIOUS NAME REGISTRATION CHANGE, COMPLETE SECTIONS 1 THROUGH 4:
I (we) the undersigned, hereby cancel the fictitious name _________________________________________________, which was
registered on _____________________________ and assigned registration number _____________________________.
_______________________________________ ___________ _______________________________________ ___________
Signature of Registrant Whose Registration is Being Cancelled
Date
Signature of Registrant Whose Registration is Being Cancelled
Date
Mark the applicable boxes
Certificate of Status - $10
Certified Copy - $30
NON-REFUNDABLE PROCESSING FEE: $50
CR4E001 (11/17)
APPLICATION FOR REGISTRATION OF FICTITIOUS NAME
Note: Acknowledgments/certificates will be sent to the address in Section 1 only.
____________________________________________________
1.
Fictitious Name to be Registered (see instructions for certain prohibited words, abbreviations and designations)
________________________________________________________________________________________________
2.
________________________________________________________________________________________________
Mailing Address of Business
___________________________________________
____________________________
_________________
City
State
Zip
3.
Florida County of principal place of business:
_________________________________________
_______________________________________________________________________________________________
(see instructions if more than one county)
4.
FEI Number of Business:
_________________________________________________
This space for office use only
A. Registrant if individual(s): (Use an attachment if necessary):
1.
____________________ ____________________ _____ 2. ____________________ ____________________ _____
Last
First
M.I.
Last
First
M.I.
_____________________________________________________________________
_____________________________________________________________________
Address
Address
___________________________________ ___________________ _____________
___________________________________ ___________________ _____________
City
State
Zip
City
State
Zip
B. Registrant if other than an individual(s): (Use an attachment if necessary):
______________________________________________
2. ______________________________________________
Entity Name
Entity Name
_____________________________________________________________________
_____________________________________________________________________
Address
Address
___________________________________ ___________________ _____________
___________________________________ ___________________ _____________
City
State
Zip
City
State
Zip
Florida Document Number: _______________________
Florida Document Number: _______________________
FEI Number: ____________________________
FEI Number: ____________________________
Applied for
Not Applicable
Applied for
Not Applicable
I the undersigned, being a registrant for the above fictitious name, certify that the information indicated on this form is true and
accurate. In accordance with Section 865.09, F.S., I further certify that the intention to register 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 in which the principal
place of business of the registrant is or will be located. I understand that the signature below shall have the same legal effect as if
made under oath and 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.
________________________________________________________ ________________
___________________________________________________________________________
Signature of Registrant in Section 2
Date
Email address: (to be used for future renewal notifications)
FOR
CANCELLATIONS,
COMPLETE THIS SECTION 4 ONLY:
FOR FICTITIOUS NAME REGISTRATION CHANGE, COMPLETE SECTIONS 1 THROUGH 4:
I (we) the undersigned, hereby cancel the fictitious name _________________________________________________, which was
registered on _____________________________ and assigned registration number _____________________________.
_______________________________________ ___________ _______________________________________ ___________
Signature of Registrant Whose Registration is Being Cancelled
Date
Signature of Registrant Whose Registration is Being Cancelled
Date
Mark the applicable boxes
Certificate of Status - $10
Certified Copy - $30
NON-REFUNDABLE PROCESSING FEE: $50
CR4E001 (11/17)
Instructions for Completing Application for Registration of Fictitious Name
Section 1:
Line 1: Enter the name as you wish it to be registered. A fictitious name may not contain words, abbreviations or designations that
comprise a business entity suffix or indicator (e.g., “Corporation,” “Incorporated,” “Professional Association,” “Limited Liability
Company,” “Professional Limited Liability Company,” “Limited Liability Partnership,” “Limited Partnership,” “Corp.,” “Inc.,” “P.A.,”
“L.L.C.,” “P.L.L.C.,” “L.L.P.,” “L.P.,” etc.) unless the person or business for which the name is registered is a business entity of the
same type duly incorporated, organized, formed or registered in Florida or otherwise authorized to transact business in Florida.
Business entities are not required to file under their exact entity name.
Section 655.922, Florida Statutes, prohibits anyone other than financial institutions to use the word(s) "bank," "banc," "banco,"
'banque," "banker," "trust company," "savings and loan association," "savings bank," or "credit union," or words of similar import.
Line 2: Enter the mailing address of the business. 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 REGISTRATION FORM WILL BE SENT TO THE ADDRESS IN SECTION 1. An address
may be changed at any future date with no charge by simply writing the Division.
Line 3: Enter the name of the county in Florida where the principal place of business of the fictitious name is located. If there is
more than one county, list all applicable counties or state “multiple”.
Line 4: Enter the Federal Employer Identification (FEI) number if known or if applicable. Please do not enter your social security
number.
Section 2:
Part A: Complete if the registrant(s) of the fictitious name are individuals. The individual’s name and address must be provided.
Part B: Complete if the registrant (s) are not individuals. Examples are a corporation, limited liability company, limited partnership,
joint venture, general partnership, trusts, etc. Provide the name of the registrant(s), their address(es), their document number(s) as
registered with the Division of Corporations, and the Federal Employer Identification (FEI) number. An FEI number must be provided
for each registrant or the appropriate box must be checked.
Registrants listed in Part B must be registered with the Division of Corporations or provide documentation as to why they are not
required to register. Examples would be Federally Chartered Corporations, or Legislatively created entities.
With respect to a general partnership that is not registered with the Division of Corporations, its partners are the registrants and not
the partnership entity. With respect to a general partnership that is registered with the Division of Corporations, the partnership is
the registrant.
In order for the fictitious name registration to be filed, each entity that is a registrant must be in active status with the Division of
Corporations at the time the fictitious name registration is filed.
Additional registrants may be listed on an attached page as long as all of the information requested in Part A or Part B is provided.
Section 3:
Signature of the registrant is required. It is preferred that a daytime phone number be provided in order to contact the registrant if
there are any questions about the application.
_________________________________________________________________________________________________________________________
Section 4:
TO CANCEL A REGISTRATION ON FILE: Provide fictitious name, date filed, and registration number of the fictitious name to be
cancelled. A registrant’s signature is required for cancellation.
TO CHANGE A REGISTRATION: Complete section 4 to cancel the original registration. Complete sections 1 through 3 to re-
register the fictitious name listing the new registrant(s). A registrant’s signature is required in both sections 3 and 4.
TO CHANGE THE NAME OF A REGISTRATION: Complete section 4 to cancel the original registration. Complete sections 1
through 3 to re-register the new fictitious name. A registrant’s signature is required in both sections 3 and 4.
_________________________________________________________________________________________________________________________
An acknowledgement letter will be mailed when the fictitious name registration has been filed. The acknowledgement letter and any certification
requested will be mailed to the address provided in Section 1. For Cancellations Only: please provide a mailing address on an attachment, if the
address on our records is no longer valid. To request a certificate of status and/or certified copy, please check the appropriate box(es) and include the
additional fee(s) ($10 for a certificate of status, $30 for a certified copy).
A registration or a reregistration will be in effect until December 31 of the fifth calendar year, thereafter.
Send completed application with appropriate fees to:
Courier Address
Fictitious Name Registration
Internet Address:
Division of Corporations
PO Box 6327
http://www.sunbiz.org
Clifton Building
Tallahassee, FL 32314
2661 Executive Center Circle
Tallahassee, FL 32301
The fee for registering a fictitious name is $50. Please make a separate check for each filing payable to the Department of State. Application must be
typed or printed in ink and legible.
Single
CR4E001 (11/17)
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