Certificate of DISCONTINUANCE of Doing Business Under Assumed Name (Discontinuance of "D/B/A") Dutchess County Clerk's Office, 22 Market Street, Poughkeepsie, NY 12601 Bradford H. Kendall, Dutchess County Clerk 845-486-2120 PURSUANT TO SECTION 130 OF THE GENERAL BUSINESS LAW OF NEW YORK STATE I/We certify that I/we filed a Certificate of Doing Business Under Assumed Name ("DBA") under the name: ________________________________________________________________________________________ located at the street address__________________________________________________________________ in the Dutchess County Clerk's office on ______________(date) and numbered _______________________ [(Optional: and amended by a further filing on _____________________________________________(date)] And hereby certify that I/we hereby DISCONTINUE the use of the previously filed Certificate (together with any amendments) for that said business was discontinued on ______________________(date) or that other conditions under which this business was conducted are no longer required for the following reason(s): ______________________________________________________________________________________ I/we therefore desire to file this Certificate of Discontinuance of Doing Business Under Assumed Name ("DBA") Signature:________________________________________________________ Date:_______________ Signature:________________________________________________________ Date:_______________ Signature:________________________________________________________ Date:_______________ Signature:________________________________________________________ Date:_______________ STATE OF NEW YORK COUNTY OF DUTCHESS ) ) ss: On this _______________ day of ________________, 20___, before me, the undersigned appeared ________________________________________________________________________ personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) are subscribed to the within instrument and who each acknowledged to me that he/she executed the same in his/her capacity and that by his/her signature on the instrument, the individual(s), or the person(s) upon behalf of which individual(s) acted, executed the instrument. ________________________________________________________________________ (Signature and office of the individual taking acknowledgement- Notary Public) American LegalNet, Inc. www.FormsWorkFlow.com