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STATE OF SOUTH CAROLINA SECRETARY OF STATE ADOPTION OF A FICTITIOUS NAME Corporation - Foreign Filing Fee - $10.00
TYPE OR PRINT CLEARLY IN BLACK INK
Pursuant to S.C. Code of Laws §33-15-106, the undersigned submits the following: 1. Applicant's Name (individual submitting form) _________________________________________________ 2. The legal name of the corporation is __________________________________________________________ 3. Enter the date that the Board of Directors adopted the resolution to use the fictitious name _______________ 4. Enter the Fictitious Name that the Board of Directors adopted to use for conducting business in the state of South Carolina ___________________________________________________________________________ 5. By signing and submitting this form you are affirming that the Board of Directors of the corporation duly adopted the resolution to use a fictitious name in South Carolina for conducting all business at a duly called meeting of the Board. A quorum was present for the meeting and the resolution was set forth in the minutes of the meeting. Additionally, you are the keeper of the corporate seal and of the minutes and records of the corporation and the said resolution has not been rescinded or modified.
Date ______________________
____________________________________________ Signature of Applicant
____________________________________________ Print Name of Applicant
____________________________________________ Capacity/Position of Applicant
Filing Checklist Fictitious Name form (filed in duplicate) $10.00 made payable to the South Carolina Secretary of State Self-Addressed, Stamped Return Envelope Return all documents to: South Carolina Secretary of State's Office Attn: Corporate Filings P.O. Box 11350 Columbia, SC 29211
Foreign Corp Adoption of a Fictitious Name
Form Revised by South Carolina Secretary of State, June 2007