Office of the Clark County Clerk Lynn Marie Goya Certificate of Business: Fictitious Firm Name Termination Please Print or Type Original Certificate File Number: Termination Date Effective On: Fictitious Firm Name: Mailing Address: Mailing Address City, State, Zip The undersigned do/does hereby terminate the business/ownership under this fictitious firm name. Signed By: Full Name of Authorized Signer Signature Date Street Address of Business or Residence City, State, Zip Signed By: (Use if needed) Full Name of Authorized Signer Signature Date Street Address of Business or Residence City, State, Zip By signing above, I declare (or affirm), under penalty of perjury, that all statements made in this document are true, and that I have authority to sign on behalf of and to bind the above named business/legal entity to a contract. For additional signatures, please use additional pages STATE OF SS: COUNTY OF This instrument was acknowledged before me on (Date) by (Name of individual whose signature is being notarized) Signature of Notary Public/Deputy Clerk Mail to: Lynn Marie Goya, County Clerk, Attn. FFN, Box 551604, Las Vegas NV 89155-1604 Include: Filing Fee of $15.00 payable to County Clerk, completed certificate and a self-addressed stamped envelope. Rev 09/2018 American LegalNet, Inc. www.FormsWorkFlow.com