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• i APPLICATION..FOR REGISTRATION OF FICTITIOUS NAME • Note:Acknowledgementsicertificates will be sent to the address in Section 1 only. ® 1. &ALAL71C -Tow/a& rI�.ED Fictitious Name to tre Registered (see instructions if name inciudes'Cotp'Of'Inc') . 12 JUL 2 3 FI4 2 18 c 35po L At..441.. ,(.0 1714 5 - E7 • 0 Malting Address of Business -; i`;. , Of STATE. ct y M IAM t , Lo 1Z FDA State 3L cotd'0r 7 TALLAHASSEE, FLORIDA i3. Florida County of principal place of business: • • MIAMI --PA-1>E C,J✓Nry • _I 12oI_tI_IU o 2929 - • • (see instructions If more than one county) 07/23/2•3i 12--01L!21--I I1j ). S I.00 FE(Number: This space for office use only • I A.Owner(s)of Fictitious Name if individual(s):(Use an attachment if necessary): 1. 2. Last First M.I. Last First M.I. • Address Address • , City State Zip Code City State Zip Code N 0 B.Owner(s)of Fictlttous Name if other than an individual: (Use attachment if necessary): 7+ 1. A i_PiNE `TOWING ANC . r 2. of Entity Name .. Entity Name dr 35 op N•W. &7T`, SI-A ET • Address ". ' Address Al.1AM ( ; FL. 331x-(7 ` City Stats Up Code City State Zip Coda 41 Florida Document Number ,p 0lo 0000,203 02, Florida Document Number FEI Number 20 1/301 $5D FEI Number ❑Applied for 0 Not Applicable 0 Applied for 0 Not Applicable 1-1 the undersigned.,.being an owner in the above.fictitious.name.certify that the.infnrmatino.indualed no this.tntm.is in.te.nott.arnutate.to.a.vneclanr.e wit. Section 865.09,F.S.,I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined in chapter t) 50,Florida Statutes,in the couhty where the principal place of business is located.I understand that the signature below shall have the same legal c effect as it made under oa • :nd.l am aware that false information submitted in a document to the Department of State Constitutes a third degree rfelony as prov'.•.fo ' :.:17:155,F.S. 3 to 4..,-.4t..., % WIN6J. AL-Pr/467otiJrA/GPVC • LvM i:.�� ' •r Date E-mail address:(to be used for future renewal notification) • a Number,_-. (30 5 ) 8 8°t - ABB . • . FOR CANCELLATICiN COMPLETE SECTION 4 ONLY: FOR FJCTJTJOUS NAME OR OWNERSHJP CHANGE COMPLETE SECTJOA)S 1 THRDLiGH 4: I (we) the undersigned, hereby cancel the fictitious name ra A LAC_1 i; -row/N& c. • ,•which was registered on r z(15 t I R 9 t and was assigned .. al - co registration number &e 2-36 poop .3 5 - ir2 _ Signa:!:01,..1,;(':-. -/ •, : Signature of Owner .Zea Mark the.appiicable boxes 0 Certificate of Status—$10 0 Certified Copy 3T,i. 41 .1 NON-REFUNDABLE PROCESSING FEE: $50 CR4E001(9/10)