Termination of Certificate of Business: Fictitious Firm Name Certificate File Number ____________________ Certificate filed on____________20______ The undersigned do/does hereby terminate ___ terminate business name ___ terminate ownership under the fictitious firm name (Print or Type) _______________________________________________________________ (Fictitious Business Name) located at ________________________, Nevada, the effective date of termination being_________________. ( City) (Date) Terminate ownership of the following person(s) whose name(s) and address (es) are as follows: (1)_____________________________________ Full Name and title (Type or Print) ___________________________________________ Signature Date ___________________________________________________________________________________ Street Address City, State, Zip ___________________________________________________________________________________ Mailing Address, if different from above City, State, Zip (2)_____________________________________ Full Name and title (Type or Print) ___________________________________________ Signature Date ___________________________________________________________________________________ Street Address City, State, Zip ___________________________________________________________________________________ Mailing Address, if different from above City, State, Zip (3)_____________________________________ Full Name and title (Type or Print) ___________________________________________ Signature Date ___________________________________________________________________________________ Street Address City, State, Zip ___________________________________________________________________________________ Mailing Address, if different from above City, State, Zip (4)_____________________________________ Full Name and title (Type or Print) ___________________________________________ Signature Date ___________________________________________________________________________________ Street Address City, State, Zip ___________________________________________________________________________________ Mailing Address, if different from above City, State, Zip (For additional names or signatures, please attach a separate sheet.) Termination Certificate File Number ______________ Mail to: Shirley B. Parraguirre, County Clerk, Attn. FFN, P.O. Box 551604, Las Vegas NV 89155-1604 Include: Filing Fee of $15.00, original plus 2 copies and self-addressed stamped envelope 02/26/04 American LegalNet, Inc. www.FormsWorkflow.com