MINNESOTA SECRETARY OF STATE
REQUEST FOR CANCELLATION OF ASSUMED NAME
READ THE INSTRUCTIONS BEFORE COMPLETING THIS FORM
For your convenience, this form has been designed to be completed online. You must have Acrobat Reader 7.0 or above to use this new feature. Once your form is completed, be sure to select "Print" at the bottom of the screen to capture your data entry for printing. After printing, sign and send applicable fees as required.Note: Selecting "Reset" will clear all data entry from this page. To print a blank form, go to File->Print.
_____________________________________________________________________ Assumed Name _____________________________________________________________________ File Number _____________________________________________________________________ Filing Date
I certify that the foregoing is true and accurate and that I have the authority to sign this document and I further certify that I understand that by signing this document, I am subject to the penalties of perjury as set forth in section 609.48 as if I had signed this cancellation under oath.
Signature of Partner(s): ________________________________________________
Print Name: ________________________________________________
________________________________________________
________________________________________________
_____________________________________________________________________ Name & phone number of contact person
INSTRUCTIONS
Please print legibly. Type or print with black ink. All of the information on this form is public and required in order to process this filing. Failure to provide the requested information will prevent the Office from approving or further processing this filing. All current nameholders must sign this cancellation form. Please include attachments if necessary. There is no fee for cancelling an Assumed Name. FILE IN-PERSON OR MAIL TO: Minnesota Secretary of State - Business Services Retirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St Paul, MN 55103 (Staffed 8:00 - 4:00, Monday - Friday, excluding holidays)
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To obtain a copy of a form you can go to our web site at www.sos.state.mn.us , or contact us between 9:00am to 4:00pm, Monday through Friday at (651) 296-2803 or toll free 1-877-551-6767.
Bus92 Request For Cancellation Of Assumed Name Rev. 5-07