Free Microsoft Word - app for cancel of reserv name-all entities.DOC - Connecticut

APPLICATION FOR CANCELLATION OF RESERVED NAME Domestic or Foreign All Entities
C.G.S. §§ 33-656; 33-1046; 34-103; 34-139; 34-407; 34-506

FILING FEE: $30.00

Make checks payable to "Secretary of the State"

Website Address: www.concord.sots.ct.gov Telephone Number: (860) 509-6003 Mailing Address: Connecticut Secretary of the State, Commercial Recording Division P.O. Box 150470, Hartford, CT Courier Delivery Address ONLY: (i.e. FedEx, UPS, etc.) 30 Trinity Street, Hartford, CT 06106 USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. (Attach 8 ½ x 11 sheet if necessary)

06115-0470

IMPORTANT: THIS FORM DOES NOT CANCEL/DISSOLVE YOUR ENTITY. YOU MUST FILE THE APPROPRIATE FORM WITH THIS OFFICE TO DISSOLVE/CANCEL/WITHDRAW YOUR BUSINESS ENTITY.

The undersigned hereby applies to cancel the reservation of the following name: 1. Reserved name: 2. Name of applicant (NOTE: The name of the applicant must EXACTLY match the name on record of the party under whose name the reservation was filed): 3. Address of applicant: (Complete address required. Street name, city, state & zip code.) ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ 4. Execution: __________________________________________________________________ SIGNATURE OF APPLICANT (print name and title, if applicable)

Revised 9/29/08

CONNECTICUT SECRETARY OF THE STATE