The undersigned [Individual or Partnership or Corporation],
certifies the following:
1. The undersigned, [Name], [Individual or
Partnership or Corporation], ceased to use the fictitious
name of [Business Name] in transacting business in the State
of [State].
2. [If NOT a corporation, then use the following]
The full [Name or names] and [Place or places]
of residence of the undersigned [Name] [is, are] as
follows: [Insert pertinent information here].
[If a corporation, then use the following]
The principal place of business of said corporation
in the State of [Name of State], is at [Address]
in the City of [Name of City], County of [Name of County].
3. The above mentioned fictitious name is hereby
abandoned.
Dated: [Date]
____________________________
[Signature(s)]
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