Free Microsoft Word - cert of cancel - domestic stat trust.DOC - Connecticut

CERTIFICATE OF CANCELLATION
DOMESTIC STATUTORY TRUST
Office of the Secretary of the State
MAILING ADDRESS: Commercial Recording Division Connecticut Secretary of the State P.O. Box 150470 Hartford, CT 06115-0470 860-509-6003
Space for Office Use Only

DELIVERY ADDRESS: Commercial Recording Division Connecticut Secretary of the State 30 Trinity Street Hartford, CT 06106 860-509-6003

Filing Fee: $60.00

Make Checks Payable To "Secretary of the State"

1. NAME OF STATUTORY TRUST:

2. THE DATE OF FILING OF THE ORIGINAL CERTIFICATE OF TRUST: _____/_____/______ 3. THE REASON FOR FILING THE CERTIFICATE OF CANCELLATION:

4. EXECUTION: Dated this _________________day of ____________________, 20______. Print or type name of signatory ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Capacity of signatory ________________________ ________________________ ________________________ ________________________ ________________________ Signature ________________________________ ________________________________ ________________________________ ________________________________ ________________________________
REV. 08/24/2007