ABANDONMENT OF FICTITIOUS BUSINESS NAME The following persons [list names, partnership, or corporation] were conducting business as [set forth fictitious name] at [address including street, city, county, and state]. The undersigned person hereby certifies that [name of business]has ceased to use the fictitious name in transacting business within the State of [State] The complete names and addresses of the individuals or of each general partner or name of corporation who conducted business under that name are as follows: The above fictitious name is hereby abandoned. Dated: _________________________________ Signature Statement filed with the County Clerk of [County], State of [State] on [day] [month], [year]