NOTICE OF INTENTION TO REGISTER A FICTITIOUS NAME
(State of Florida – § 865.09, F.S.)

[// GUIDANCE: This template satisfies the publication component of Florida’s Fictitious Name Act, Fla. Stat. § 865.09. It is drafted for placement in a newspaper of general circulation in the county where the Registrant’s principal place of business is located. Complete all bracketed fields before submission. Retain proof of publication for your records and for filing/renewal purposes.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions (Notice Text)
IV. Representations & Warranties
V. Renewal & Compliance Schedule
VI. General Provisions
VII. Execution Block

I. DOCUMENT HEADER

1. Document Title: “Notice of Intention to Register a Fictitious Name (DBA) – State of Florida”
2. Effective Date of Notice: [MM/DD/YYYY]
3. Jurisdiction: State of Florida
4. Governing Law: Florida Fictitious Name Act, § 865.09, Fla. Stat.
5. Forum for Statutory Filings: Florida Department of State, Division of Corporations

II. DEFINITIONS

For purposes of this Notice, the following terms shall have the meanings set forth below:

“Department” means the Florida Department of State, Division of Corporations.

“Fictitious Name” or “DBA” means the name under which the Registrant will transact business in Florida that is different from the Registrant’s legal name.

“Notice” means this Notice of Intention to Register a Fictitious Name, prepared for newspaper publication pursuant to § 865.09(3)(a), Fla. Stat.

“Registrant” means the individual(s) or legal entity(ies) identified in Section III as the party(ies) intending to engage in business under the Fictitious Name.

III. OPERATIVE PROVISIONS (NOTICE TEXT)

[Begin Newspaper Copy – place exactly as completed below]

NOTICE IS HEREBY GIVEN that the undersigned, desiring to engage in business under the fictitious name
“[FICTITIOUS NAME]”
located at [STREET ADDRESS, CITY, COUNTY, FL ZIP], intends to register said name with the Florida Department of State, Division of Corporations, Tallahassee, Florida, in accordance with the provisions of Section 865.09, Florida Statutes.

1. Name of Registrant(s):
   a. [FULL LEGAL NAME OF PERSON OR ENTITY #1]
   – Business Structure: [e.g., Florida Limited Liability Company / Corporation / Individual / Partnership]
   – FEI/EIN or Florida Document Number (if applicable): [NUMBER]
   b. [FULL LEGAL NAME OF PERSON OR ENTITY #2] (if any)
   – Business Structure: [STRUCTURE]
   – FEI/EIN or Florida Document Number (if applicable): [NUMBER]

2. Principal Place of Business:
   [STREET ADDRESS, CITY, FL ZIP]

3. Mailing Address (if different):
   [MAILING ADDRESS, CITY, STATE, ZIP]

4. Effective Date of Intended Registration: [MM/DD/YYYY]

5. Signature of Registrant(s) or Authorized Representative(s):

[NAME], [TITLE]
Date Signed: [MM/DD/YYYY]

[End Newspaper Copy]

[// GUIDANCE: Insert “CLASSIFIED” or other placement headers required by the selected newspaper. Most Florida newspapers accept 1-to-4-line notices; confirm length and formatting requirements in advance.]

IV. REPRESENTATIONS & WARRANTIES

4.1 Authority. Each Registrant represents and warrants that it possesses full power and authority to adopt and use the Fictitious Name in the State of Florida.

4.2 Non-Infringement. Registrant represents that, to the best of its knowledge and after reasonable diligence, use of the Fictitious Name will not infringe or otherwise violate the trademark, service mark, or other intellectual-property rights of any third party.

4.3 Accuracy. Registrant warrants that all information contained in this Notice is true, correct, and complete as of the Effective Date.

4.4 Survival. The representations and warranties in this Section IV shall survive filing, publication, and any subsequent renewal of the Fictitious Name registration.

V. RENEWAL & COMPLIANCE SCHEDULE

5.1 Initial Registration Filing. Registrant shall file the corresponding “Application for Registration of Fictitious Name” with the Department within FIVE (5) BUSINESS DAYS after the first publication date of this Notice.

5.2 Proof of Publication. Registrant shall retain the newspaper’s Affidavit of Publication for a minimum of FIVE (5) YEARS and shall furnish such proof to the Department upon request.

5.3 Renewal Deadline. Pursuant to § 865.09(5)(a), Fla. Stat., registration of a fictitious name expires on DECEMBER 31 of the fifth calendar year following its registration. Renewal filings may be submitted from JULY 1 through DECEMBER 31 of the expiration year.

5.4 Non-Renewal Consequences. Failure to renew timely shall result in administrative cancellation of the fictitious name, rendering the Registrant ineligible to lawfully transact business under the un-renewed name.

VI. GENERAL PROVISIONS

6.1 Amendments. Any change to the information contained herein (including change of ownership, address, or cessation of use) must be reported to the Department by filing an Amendment or Cancellation of Fictitious Name within THIRTY (30) DAYS of the change.

6.2 Severability. If any provision of this Notice is held invalid under applicable law, such invalidity shall not affect the remaining provisions, which shall remain in full force and effect.

6.3 Entire Notice. This document, together with the corresponding Department filing, constitutes the entire statement of intention to register the referenced Fictitious Name as required by Florida law.

VII. EXECUTION BLOCK

IN WITNESS WHEREOF, the undersigned executes this Notice on the date(s) set forth below.

Registrant or Authorized Representative:

Printed Name: [NAME]
Title/Capacity: [TITLE or “Owner”]
Date: [MM/DD/YYYY]

(If multiple owners, duplicate signature lines as needed.)

[NOTARIZATION – OPTIONAL]
State of Florida )
County of _______ )

Sworn to (or affirmed) and subscribed before me on this _ day of ___, 20, by _________ (name of person making statement).

Notary Public, State of Florida
[Stamp/Seal]

END OF TEMPLATE

[// GUIDANCE:
1. Submit the completed Notice to an appropriate newspaper BEFORE filing the Application for Registration with the Florida Department of State.
2. Retain the notarized proof of publication for inclusion with renewal filings or in response to Department inquiries.
3. This template is court-ready but should be reviewed for client-specific adjustments, especially where ownership structure is complex or trademark clearance is advisable.]