First Name:
Middle Name:
Middle Initial:
Family Name:
Gender:
manwoman
(Names will be converted to upper/lower case where needed in the certificate.)
I the undersigned, being an owner of the fictitious name, certify that the information indicated on this form is true and accurate. I further certify that this claim of ownership is to be recorded by the People’s Court of Terra Australis for preservation in the Book of Deeds.
I understand that by submitting this claim online, I have agreed to the electronic autograph below and that this application shall have the same legal effect as if made under oath. I am also aware that by submitting false information on this application I would be guilty of committing perjury, for which I may be prosecuted. I accept full liability for this submission.
Autograph of Living Owner
Email Address of Living Owner
(Not all details are displayed for privacy reasons)
Jonathon Coombes
