CANCELLATION OF FICTITIOUS NAME
Select entity type:
For-Profit Corporation ($25.00 fee)
General Partnership
($15.00 fee)
LLC ($25.00 fee)
LLLP ($15.00 fee)
The undersigned, pursuant to the laws of the State of Arkansas, hereby requests that the following
fictitious name be canceled:
1. The fictitious name under which the business is being conducted by this entity is:
________________________________________________________________________________
2. a) The entity name of the applicant and its date of qualification in Arkansas: Date: _______________
Name: ___________________________________________________________________________
b) The entity is
Domestic
Foreign (state of domestic registration) ________________
c)
The location (city and street address) of the registered office of the applicant entity in Arkansas is:
_________________________ _________________________ __________ ______________
Street City State ZIP Code
I understand that knowingly signing a false document with the intent to file with the Arkansas
Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or impris-
onment up to 30 days.
Authorizing Officer _________________________________________________________________
(Type or Print)
Authorized Signature: ______________________________________________________________
(Chairman, Partner or other authorized person)
Address: _________________________________________________________________________
CFN Rev. 09/19
Arkansas Secretary of State
1401 W. Capitol, Suite 250,
501-682-3409 • www.sos.arkansas.gov
Little Rock, AR 72201
Nonprofit Corporation ($25.00 fee)
Limited Partnership ($15.00 fee)
LLP ($15.00 fee)
(Make Checks Payable To: Arkansas Secretary of State)
John Thurston
Filing Fee: $25.00
