CERTIFICATE OF DISCONTINUANCE OF BUSINESS
Pursuant to General Business Law § 130, I hereby certify that I have conducted or transacted
business under the assumed name
at
in the County of Suffolk, State of New York, and that a certificate of conducting business under an
assumed name was filed in the office of the County Clerk, County of Suffolk, on the day of
, under index # ; and that the last amended certificate under index [# ]
was filed on the day of , in the office of the said County Clerk; and
I hereby further certify that the filing of a certificate in said County is no longer required for the
reason that the said business was discontinued on the day of , or the conditions
under which the business is conducted have changed so that the filing of a certificate in said County is no
longer required for the reason that:
I therefore desire to file this certificate of discontinuance.
IN WITNESS WHEREOF, I have signed this certificate on the day of , .
[Signature]
Acknowledgment in New York State (RPL § 309-a)
STATE OF NEW YORK )
) ss.:
COUNTY OF )
On the day of in the year before me, the undersigned, personally
appeared
, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is
(are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies),
and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument.
COD - 4
Notary Public
