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Termination of Business Under a Fictitious or Assumed Name

This document will certify:

{Company name}, which operates at {address}, filed a certificate on {date}, in


which it declared its intention to operate under the assumed or fictitious name of
{name}.

This certificate is no longer necessary because {corporation is terminated,


company will no longer use the assumed or fictitious name}.

The undersigned is a representative of the company, and is authorized to sign on


the company's behalf.

Signed this {date} day of {month}, {year}.

Company Rep Printed Name Company Rep Signature

Notary Seal:

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