Do I need a notary for the Statement of Abandonment?

No. The form provides a signature and date field without a notary block. Its instructions separately require an affidavit of publication after the statement is published.

How do I submit the abandonment statement?

Submit it to the Siskiyou County Clerk-Registrar of Voters at 311 4th St., Rm. 201, Yreka, CA 96097. The form lists a $14.50 filing fee.

What information does the form ask for?

It asks for the fictitious business name and address, the original statement's filing date and file number, registrant information, and a registrant signature.

What happens after the statement is filed?

The instructions say to publish the statement in a newspaper once a week for four successive weeks, then file an affidavit of publication with the County Clerk.

Siskiyou County, CA · Siskiyou County

No notary required

Statement of Abandonment of Use of Fictitious Business Name

Fictitious business name registrants use this form to report that they have stopped conducting business under a name filed in Siskiyou County.

At a glance

Issued by: City of Siskiyou County · Siskiyou County, Siskiyou County, California
Notarization: Not required: file this form without a notary.
Official source: siskiyoucounty.gov
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

Use this form when ending business activity under a fictitious business name filed in Siskiyou County within the previous five years. It asks for the name and business address, the original filing date and file number, registrant details, and a signature. The instructions say the statement must be published in a newspaper and an affidavit of publication filed with the County Clerk after publication.

Who needs it

A person or business registrant that has stopped using a fictitious business name filed in Siskiyou County within the previous five years needs this form.

How to submit it

Submit the form to the Siskiyou County Clerk-Registrar of Voters, 311 4th St., Rm. 201, Yreka, CA 96097. The form lists a $14.50 filing fee.

About notarization

This form is signed and dated without a notary; its instructions also require filing an affidavit of publication after the statement has been published.

How to submit this form

1
Download the Form
Download the Statement of Abandonment of Use of Fictitious Business Name.
2
Complete the Form
Enter the business name and address, original filing details, registrant information, and the required signature and date.
3
Arrange Publication
The instructions require publication in a newspaper once a week for four successive weeks.
4
Submit to the County
Submit the completed statement to the Siskiyou County Clerk-Registrar of Voters; the form lists a $14.50 filing fee.
5
File Proof of Publication
After publication, file an affidavit of publication with the County Clerk.

Frequently asked questions

Do I need a notary for the Statement of Abandonment?: No. The form provides a signature and date field without a notary block. Its instructions separately require an affidavit of publication after the statement is published.
How do I submit the abandonment statement?: Submit it to the Siskiyou County Clerk-Registrar of Voters at 311 4th St., Rm. 201, Yreka, CA 96097. The form lists a $14.50 filing fee.
What information does the form ask for?: It asks for the fictitious business name and address, the original statement's filing date and file number, registrant information, and a registrant signature.
What happens after the statement is filed?: The instructions say to publish the statement in a newspaper once a week for four successive weeks, then file an affidavit of publication with the County Clerk.

Need something notarized?

This Statement of Abandonment of Use of Fictitious Business Name doesn’t need a notary, but if you have another Siskiyou County form that does, a commissioned online notary can help.