Free Filing Fee - Rhode Island

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Office of the Secretary of State Corporations Division 148 W. River Street Providence, Rhode Island 02904-2615 (401) 222-3040

INSTRUCTIONS FOR FILING FICTITIOUS BUSINESS NAME STATEMENT
Section 7-6-11 of the General Laws of Rhode Island, 1956, as amended The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant statutory provision. This form and the information provided are not substitutes for the advice and services of an attorney and/or tax specialist. 1. Any non-profit corporation organized under the laws of, or qualified to conduct affairs in this state may transact its affairs in this state under a fictitious business name provided that it files a Fictitious Business Name Statement (Form No. 626) with the Office of the Secretary of State, Corporations Division, at the above address. 2. When the Statement is properly completed, signed and submitted with the correct filing fee, the Fictitious Business Name Statement shall be filed. 3. The fictitious name of any non-profit corporation must be "distinguishable upon the records of the secretary of state." This means the Office of the Secretary of State will deny a request for a name if such name is identical to or not distinguishable from any entity, name reservation, or registration on file with the Business Section of the Corporations Division. A preliminary name availability check can be made by checking the Name Availability Database on our website, or by phoning us at the above telephone number. This preliminary check is not statutorily required, is not binding upon the Secretary of State, and does not ensure that the name will be available upon filing the Articles of Incorporation. It is suggested that you do not make any financial expenditures or execute documents utilizing the name based upon a preliminary name availability check. The final determination as to availability of the name will be made when the documents are submitted for filing. 4. The Statement must be accompanied by a filing fee of $20.00, and payment should be made payable to the Rhode Island Secretary of State. 5. Upon filing the Statement, the entity must be in good standing and current with the filing of its annual reports and the maintenance of its registered agent and its registered office in this state. 6. The Fictitious Business Name Statement shall expire upon the filing of a Statement of Abandonment of Use of Fictitious Business Name or upon the dissolution of the applicant entity. 7. The Statement shall be executed by an authorized person of the non-profit corporation or by a person with authority to do so under the laws of the state or other jurisdiction of the organization of the non-profit corporation. If you have any questions, please call us at (401) 222-3040, Monday through Friday, between 8:30 a.m. and 4:30 p.m.

Instructions/Form 626 Revised: 12/05

Filing Fee: $20.00

ID Number

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Office of the Secretary of State Corporations Division 148 W. River Street Providence, Rhode Island 02904-2615

NON-PROFIT CORPORATION _____________ FICTITIOUS BUSINESS NAME STATEMENT

Pursuant to the provisions of Section 7-6-11 of the General Laws of Rhode Island, 1956, as amended, the undersigned non-profit corporation hereby submits the following statement for authority to transact its affairs in the State of Rhode Island under a fictitious business name: 1. The name of the non-profit corporation is

2. The fictitious business name to be used is 3. The state or other jurisdiction under the laws of which it is incorporated is 4. The date of incorporation is

Under penalty of perjury, I declare that the information contained herein is true and correct. Date:
Print Name of Applicant Non-Profit Corporation

By
Signature of Authorized Person Title

Form No. 626 Revised: 12/05