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0 <br /> 0 <br /> ® APPLICATION FOR REGISTRATION OF FICTITIOUS NAME <br /> • REGISTRATION#G11000014388 <br /> Fictitious Name to be Registered: CHEN MOORE AND ASSOCIATES <br /> &tailing Address of Business: 500 W.CYPRESS CREEK ROAD <br /> ® <br /> SUITE 410 <br /> FT.LAUDERDALE,FL 33309 <br /> ® Florida County of Principal Place of Business: BROWARD FILED <br /> FE Number: Feb 07,2011 <br /> • Secretary of State <br /> e Owned')of Fictitious Name:: <br /> CHEN AND ASSOCIATES CONSULTING ENGINEERS,INC. <br /> 5C0 W.CYPRESS CREEK ROAD,#410 <br /> FT.LAUDERDALE,FL 33309 US <br /> Florida Document Number J41454 <br /> FEI Number.59-2739866 <br /> • <br /> • <br /> 0• <br /> • <br /> • <br /> • <br /> • <br /> • <br /> • <br /> 0 <br /> e <br /> I the undersigned,being an owner in the above fictitious name.certify that the information indicated on this form is true and <br /> ® accurate.I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined <br /> in Chapter 50,Florida Statutes,in the county where the principal place of business is located. I understand that the electronic <br /> ® signature below shall have the same legal effect as if made under oath and I am aware that false information submitted in a <br /> document to the Department of State constitutes a third degree felony as provided for ins.817.155,Florida Statutes <br /> ® PETER MOORE 02/07/2011Electronic Signature(s) Date <br /> • <br /> • Certificate of Status Requested( ) Certified Copy Requested( ) <br /> 6 <br /> CHEM MO (lRE REV xo.12-04-02Continuing Professional Architectural 8 Engineering Services Firms Only(CCNAJ <br /> • Category::CivilEngineering 1-3 <br /> sAssocwtts <br />