Assumed Business Name Cancellation Form Instructions
The instructions are listed in numerical order to align with the form. List the registry number.
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ASSUMED BUSINESS NAME: Name of business.
PRINCIPAL PLACE OF BUSINESS: (Street Address, City, State, Zip) Physical address where the business is located. This address may also be where the business records are kept.
SIGNATURE(S): Authorized Representative or All Registrants must sign. Declare as an authorized signer, under penalty of perjury, that this document does not fraudulently conceal, obscure, alter, or otherwise misrepresent the identity of any person including officers, directors, employees, members, managers or agents. This filing has been examined and is, to the best of your knowledge and belief, true, correct and complete. Making false statements in this document is against the law and may be penalized by fines, imprisonment, or both.