CERTIFICATE OF SALE OF BUSINESS UNDER AN ASSUMED NAME CERTIFICATE The following is hereby certified: 1. The business that has been conducted at under the name of , has been sold. 2. The names and residences of each person interested in the business, but now withdrawing from said business are: 3. Following are the names and addresses of the persons who will hereafter conduct the business: 4. The date when said person(s) withdrew from the business was , (year). Dated:__________________________ __________________________________ _________________________ __________________________________ STATE OF } COUNTY OF On before me, , personally appeared , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(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 authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature___________________________ Affiant _____Known _____Unknown ID Produced________________________ (Seal)