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Instructions for completing Statement of Abandonment – Please type or print legibly. 1. Fictitious business name(s) being abandoned. 2.This form may only be used to abandon a Placer County Fictitious Business Name. Statement that had been filed within the past five years. The statement shall be effective upon filing and the domestication shall be deemed abandoned and shall not become effective. Request tax statement from Dept. The statement of abandonment takes effect on filing, and the domestication is abandoned and does not become effective. When a statement of abandonment becomes effective, the domestication is abandoned and does not become effective. NOTE: To complete the signature electronically, you must download and save the form to enable the digital signature feature. (34) "Statement of domestication" means a statement under Section 48-3a-1055.