California Form Fnp 004 PDF Details

The California Form Fnp 004 is a state tax form that is used to report the income and losses of certain partnerships. This form must be filed by the fifteenth day of the fourth month following the close of the taxable year, and it must be accompanied by a Schedule K-1. The information reported on this form will help the state determine how much tax should be paid by the partnership. If you have any questions about how to complete this form, please contact a tax professional.

Below is some data that could be useful if you are seeking to learn how long it'll take you to complete california form fnp 004 and just how many PDF pages it has.

Form NameCalifornia Form Fnp 004
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesfnp 004 fictitious name permit california board of psychology form

Form Preview Example


Sacramento, CA 95815-5401


Licensing Program


2005 Evergreen Street, Suite 1200


Phone: (916)


Fax: (916)


Protecting consumers by advancing high quality, safe medical care.

Gavin Newsom, Governor, State of California | Business, Consumer Services and Housing Agency | Department of Consumer Affairs



Fictitious Name:

Current Physical

Practice Address:

(No PO Box)

Our records indicate that you are presently doing business as:

FNP #:


Phone #:

Renewal Fee: $



Individual (Sole Proprietor)

A hold has has not been placed on your Fictitious Name Permit. In order for the hold to be removed, this form must be completed in its entirety and signed by a current owner. Refer to the enclosed attachment indicating the current owner(s). Note: A fictitious name permit is not transferable. If a medical practice is purchased by another physician, the

former owner must submit an “Application for Cancellation of a Fictitious Name Permit” to cancel the permit and the new owner must submit a “Fictitious Name Permit Application.” Both forms should be mailed at the same time to assure the name will be available to the new owner.

If you are doing business as a corporation or as a partnership and wish to add/delete shareholders or partners, please provide the following information in the table below. Signatures are required to associate or disassociate shareholders or partners. A signature at the bottom of this form also is required to change the address or renew the permit. Refer to attachment for current owners.

Doctor’s Name (print or type)

License #














I declare under penalty of perjury under the laws of the State of California that I have read the foregoing notification and all attachments thereto and know the contents thereof. I have the legal authority to act on behalf of the above-stated entity and the information contained herein is true and correct.





Print or Type Name



License #

FNP-004 (Revised 01/2019)

How to Edit California Form Fnp 004 Online for Free

Writing the California Form Fnp 004 file is simple with this PDF editor. Stick to the following actions to get the document ready without delay.

Step 1: The first task is to pick the orange "Get Form Now" button.

Step 2: After you have entered the California Form Fnp 004 editing page you may notice the different functions you may use with regards to your document in the top menu.

For each segment, fill in the content demanded by the software.

California Form Fnp 004 fields to fill in

Include the essential data in the Corporation, Partnership, Individual Sole Proprietor, has, has not been placed on your, A hold form must be completed in, If you are doing business as a, Doctors Name print or type, License, Association Date, Disassociation Date, and Signature part.

Filling in California Form Fnp 004 step 2

The software will ask for more details with a purpose to instantly fill in the box I declare under penalty of perjury, Print or Type Name, Signature, Date, License, and FNP Revised.

Filling out California Form Fnp 004 part 3

Step 3: Select the "Done" button. Finally, you may transfer the PDF document - save it to your electronic device or deliver it by using email.

Step 4: Make sure to stay clear of possible worries by having minimally 2 duplicates of the file.

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