DOS-1625-f ( Rev. 03/17 ) Page 1 of 2 New York StateDepartment of State DIVISION OF CORPORATIONS, STATE RECORDS AND UNIFORM COMMERCIAL CODE One Commerce Plaza 99 Washington Ave. Albany, NY 12231-0001 www.dos.ny.govCERTIFICATE OF DISCONTINUANCE OF ASSUMED NAME OF (Insert Real Name of Entity) Under Section 130 of the General Business Law FIRST: The real name of the entity is: . SECOND: Foreign entities only. If applicable, the fictitious name the entity agreed to use in New York State is: . THIRD: If the real name of the entity is different on the last Certificate of Assumed Name or Certificate of Amendment of Certificate of Assumed Name, the previous name of the entity is: . FOURTH: The present assumed name is: . FIFTH: The date the original Certificate of Assumed Name was filed is: . SIXTH: The date, if applicable, the last Certificate of Amendment of Certificate of Assumed Name was filed is: . SEVENTH:The date on which the discontinuance of assumed name occurred or the reason for the discontinuance of the use of the assumed name: . American LegalNet, Inc. www.FormsWorkFlow.com DOS-1625-f ( Rev. 03/17 ) Page 2 of 2 INSTRUCTIONS FOR SIGNING: 1. If a corporation, by an officer; if a limited partnership, by a general partner; if a limited liability company, by a member or manager; or by an authorized person or attorney-in- fact for such corporation, limited partnership or limited liability company. 2. If the certificate is signed by an attorney-in-fact, include the name and title of the person for whom the attorney-in-fact is acting. (Example, John Smith, attorney-in-fact for Robert Johnson, president.) X (Name of Signer) (Signature) (Title of Signer) CERTIFICATE OF DISCONTINUANCE OF ASSUMED NAME OF (Insert Real Name of Entity) Under Section 130 of the General Business Law Filer222s Name and Mailing Address: Name: Company, if Applicable: Mailing Address: City, State and Zip Code: NOTES: 1. This form was prepared by the New York State Department of State. You are not required to use this form. You may draft your own form or use forms available at legal stationery stores. 2. The Department of State recommends that all documents be prepared under the guidance of an attorney. 3. The certificate must be submitted with a $25 fee. For Office Use Only American LegalNet, Inc. www.FormsWorkFlow.com