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• <br /> FILED <br /> APPLICATION FOR REGISTRATION OF FICTITIOUS NAME Jun 22, 2007 8:00 am <br /> Note: Acknowledgements /csrtM ottlles will be sent to the address In Section 1 onty. Secretary of State <br /> Treelawn Builders 06 -22 -2007 90080 026 * ** *80.00 <br /> 607173700076 <br /> Fictitious Name lo be Registered (see Instructions It name Includes "Corp' or "Inc, <br /> P.O. Box 506 <br /> T <br /> C Malting Address of Business <br /> Brooksville Florida 34605 -0506 5 3 3 2 7 5 <br /> Gty State Tip Code <br /> 3. Florida County of principal place of business: Hernando <br /> (see instructions 11 more than one county) This space for office use only <br /> A. Owner(e) of Fictitious Name If Individual(s): (Use an attachment If necessary): <br /> 1 Beasley Paul C. 2. <br /> Last First M.I. Last And M.I. <br /> P.O. Box 506 <br /> Address Address <br /> Brooksville Florida 34605 -0506 <br /> City State Zip Code City State Zip Code <br /> N <br /> C B. Owners) of Fictitious Name If other than an individual: (Use attachment If necessary): <br /> 1. 2. <br /> Entity Name Ently Name <br /> Address Address <br /> Gry State Zip Code City State Zip Code <br /> Florida Registration Number Florida Registration Number <br /> FEI Number: FEI Number: <br /> ❑ Applied for 0 Not Applicable ❑ Applied for ❑ Not Applicable <br /> I (we) the undersigned, being the sole (all the) party(lea) owning interest In the above liictftious•name, certify that the information indicated on this form <br /> is true rate. (At In Leas accordance with gnatu R Sect i red) ion 865.09• FS., I (we) understand that the s)gnalure(s) below shall have the same legal effect as if <br /> ma Si - • <br /> O • i <br /> C3 / t�/ ` `/ • /7 <br /> Signature a Owner 1 . Signature of Owner Date <br /> Phone Number: (352) 796 -2433 Phone Number: <br /> FOR CANCELLATION COMPLETE SECTION 4 ONLY: <br /> FOR FICTITIOUS NAME OR OWNERSHIP CHANGE COMPLETE SECTIONS 1 THROUGH 4: <br /> Tr 1 (we) the undersigned, hereby cancel the fictitious name <br /> o , which was registered on and was assigned <br /> ca registration number <br /> Signature of Owner Date Signature of Owner Date <br /> Mark the applicable boxes 0 Certificate of Status — $10 ® Certified Copy — $30 <br /> NON - REFUNDABLE PROCESSING FEE: $50 <br /> Single CR4E001 (11/03) <br />