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WITHDRAWAL OF TRADE NAME REPORT
TO: OKLAHOMA SECRETARY OF STATE 2300 N. Lincoln Blvd., Room 101, State Capitol Building Oklahoma City, Oklahoma 73105-4897 (405) 521-3912
The undersigned "business entity" hereby submits the following withdrawal of trade name report pursuant to Title 18, Oklahoma statutes, Section 1140.1: 1. The legal name of the "Business Entity" is: 2. The type of "Business Entity" is: (Please Note: "BUSINESS ENTITY" means a corporation, a business trust, a common law trust, a limited liability company, or any unincorporated business, including any form of partnership.) 3. The business entity was formed in the State/Country of: 4. The business entity is no longer doing business in the state of Oklahoma under the following trade name:
I/we, being duly authorized to sign on behalf of the above named business entity, do hereby execute this report on the day of , .
Signature (List title if applicable
Signature ) (List title if applicable )
(Type or Print Name)
(Type or Print Name)
(SOS FORM 0040-12/01)