Free affidavit of identity 35
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KERN COUNTY
AUDITOR-CONTROLLER-COUNTY CLERK
MARY B. BEDARD, CPA

AFFIDAVIT OF IDENTITY – FICTITIOUS BUSINESS NAME STATEMENT
In accordance with Section 17913 of the CA Business and Professions Code, the following identifying information is required to
file a Fictitious Business Name Statement.
This certificate must be signed in the presence of a Notary Public (mail/drop-off) OR Deputy County Clerk (in person).
Registrant Name

__

______________

First Name

Last Name

Name of Business

______________

Registrant Address

_____________
Street Address

____________
City

I,

State

_____________________

Zip Code

_, declare under penalty of perjury under the laws of the State of California,

that I am the registrant and intend to file this Fictitious Business Name. I understand that if I willfully make a false statement on
this affidavit, I may be punished by a fine not to exceed one thousand dollars ($1,000).
Signed on this

day of ________
(Day)

20

__.

(Month)
(Signature)

If filin