PDF document

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!
State of Rhode Island This legal document
Department of State - Business Services Division should be typed.
All illegible
documents
Instructions for Filing will be REJECTED.
Business Corporation Fictitious Business Name Statement
Section 7-1.2-402 of the General Laws of Rhode Island, 1956, as amended
The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant statutory provision.
This form and the information provided are not substitutes for the advice and services of an attorney and/or tax specialist.
All filings are public records under RIGL 38-2-1, et seq. This means all information is available to the public by a variety
of methods including, without limitations, inspections at our office, telephone inquiries and electronically through our online
database.

How to complete the form: How to pay the filing fee:
1. List the entity’s ID number. The ID number can be found The filing fee is payable either by mail via check made
by looking up your entity in the Corporate Database. payable to RI Department of State or in person via cash,
2. List the name of the corporation. The entity name can be credit card, or check at the Business Services Division, 148
verified through our Corporate Database. If the corporate W. River Street, Ste. 1, Providence, RI 02904. Contact our
name has changed an amendment, form 101 or form office at (401) 222-3040 for further information.
151, must be filed with this office. Electronic filing may be
available. How to confirm your filing:
3. List the fictitious business name the entity would Entity records are retrievable and viewable through our
like to use. Your fictitious business name must be website. Successful filings will NOT result in a mailed
distinguishable from any name on file in this office. You confirmation. Filings that cannot be processed will be posted
may check name availability on our website; however, online and then returned. To confirm your submission and
this does not ensure the name will still be available upon obtain evidence of your filing:
filing.
• Go to our Corporate Database.
4. List the state or country of incorporation.
• Enter the name or ID number of your entity and click
5. Domestic entities MUST list the date of incorporation. “Search.”
Foreign entities MUST list the date of qualification • Click on the link to your entity record, scroll down,
in Rhode Island. The entity’s date of incorporation/ select “All Filings” and then “View Filing.”
qualification can be verified through our Corporate • Identify the desired type of filing and click on “PDF”
Database. under “View PDF” to view and print the record.
6. List the address of the registered office as PRESENTLY
shown in the corporate records on file with our office.
How to maintain your status:
The entity’s registered office can be verified through our
Corporate Database. The entity is responsible for filing an annual report each
7. List the business the fictitious business name is engaged calendar year, excluding the year of incorporation, between
in. February 1 and May 1. A courtesy reminder will be mailed
to the registered agent prior to February 1 of each year. Be
8. Applicant is otherwise authorized to do business in the sure to follow up with your registered agent concerning the
state of Rhode Island. filing of this report. Failure to file an annual report or maintain
9. An Authorized Officer of the corporation MUST sign and a registered agent/office will result in revocation proceedings.
date the form.
Every entity registered with the RI Department of State -
Business Services Division will have filing requirements with
the Rhode Island Division of Taxation, even if no business
is conducted within Rhode Island for a particular year. Your
business may require additional licensing. Please visit our
website for further information.

FORM 624A - Revised: 04/2023

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State of Rhode Island
Department of State - Business Services Division

Fictitious Business Name Statement STAMP
DOMESTIC or FOREIGN Business Corporation FOR
SECRETARY OF STATE
Filing Fee: $50.00 USE ONLY

Pursuant to the provisions of RIGL 7-1.2-402, the undersigned business corporation hereby submits
the following statement for authority to transact business in the state of Rhode Island under a
fictitious business name:
1. Entity ID Number: 2. The name of the Corporation is:

3. The fictitious business name to be used is:

4. The corporation is organized under the laws of: 5. The date of incorporation is:

6. The address of its registered office within Rhode Island is:
Street Address

City State Zip
RHODE ISLAND

7. The business in which it is engaged:

8. Applicant is otherwise authorized to do business in the state of Rhode Island.
9. Under penalty of perjury, I declare and affirm that I have examined this Fictitious Business Name Statement and that the
information contained herein is true and correct.
Name of Authorized Officer of the Corporation Date

Signature of Authorized Officer of the Corporation

MAIL TO:
Division of Business Services
148 W. River Street, Providence, Rhode Island 02904-2615 STAMP
Phone: (401) 222-3040
Website: www.sos.ri.gov FOR
SECRETARY OF STATE
USE ONLY

If you have any questions, please call us at (401) 222-3040, Monday through Friday,
between 8:30 a.m. and 4:30 p.m., or email corporations@sos.ri.gov.
FORM 624A - Revised: 04/2023

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        State of Rhode Island
        Department of State - Business Services Division

Filer Contact Information
        
In the event our office needs more information in order to complete the filing of this          
document, we ask for the filer’s contact information. All fields are REQUIRED.

Name:                                                                               Date:

Entity Name:

Street Address:

City:                                                 State:                        Zip Code:

Email Address:                                                                      Phone Number:

If you have any questions, please call us at (401) 222-3040, Monday through Friday, 
between 8:30 a.m. and 4:30 p.m., or email corporations@sos.ri.gov.
                                                                                    FORM 624A - Revised: 04/2023

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