Get Application To Record A Fictitious Name - Pennsylvania's Enterprise ... - Portal State Pa

Filing the Application To Record A Fictitious Name in Pennsylvania is a crucial step for businesses wishing to operate under a fictitious name. This guide provides you with clear, step-by-step instructions to help you complete the online application process efficiently.

Follow the steps to fill out the application seamlessly.

1. Click ‘Get Form’ button to access the application and open it for editing.
2. In the first section, enter the fictitious name you intend to use. Ensure it is unique and not already in use by another entity in Pennsylvania.
3. Provide the street address of the facility where this fictitious name will be used. Fill in the city, state, and the ZIP code accurately.
4. Enter the telephone number for the facility. Ensure that this number is a valid contact for business inquiries.
5. If applicable, provide the Pennsylvania license number associated with the dental facility.
6. List the name of the responsible dentist regarding this application. Remember, only one dentist can be designated as responsible.
7. Fill in the name of the owner of the dental facility.
8. If the facility is incorporated, document the date of incorporation.
9. List all licensed personnel practicing at the facility, including dentists, dental hygienists, and assistants. You may need to document additional names on a separate sheet if there are many.
10. After completing the form, have the responsible dentist sign and date it to confirm accuracy.
11. Lastly, submit a check or money order for $35.00 made payable to the ‘Commonwealth of PA’ along with the application. Keep a copy of the application and documents submitted for your records.

Complete your application online today to ensure your fictitious name is officially recorded!