Free Filing Fee - Rhode Island

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Office of the Secretary of State Corporations Division 148 W. River Street Providence, Rhode Island 02904-2615 (401) 222-3040

INSTRUCTIONS FOR FILING STATEMENT OF ABANDONMENT OF USE OF FICTITIOUS BUSINESS NAME
Section 7-1.2-402, 7-16-9, and 7-13-2 of the General Laws of Rhode Island, 1956, as amended The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant statutory provision. This form and the information provided are not substitutes for the advice and services of an attorney and/or tax specialist. 1. Any entity organized and existing under the laws of any state or territory of the United States may abandon a fictitious business name by filing a Statement of Abandonment of Use of Fictitious Business Name (Form No. 625) with the Office of the Secretary of State, Corporations Division, at the above address. 2. When the Statement of Abandonment of Use of Fictitious Business Name is completed, signed and submitted with the correct filing fee, the Statement of Abandonment shall be filed. 3. The Statement of Abandonment of Use of Fictitious Business Name must be accompanied by a filing fee of $50.00, and payment should be made payable to the Rhode Island Secretary of State. 4. Upon filing the Statement of Abandonment of Use of Fictitious Business Name, the entity must be in good standing and current with the filing of its annual reports and the maintenance of its registered agent and registered office in this state. 5. The Statement of Abandonment of Use of Fictitious Business Name shall be executed by an authorized officer, if the applicant entity is a corporation, or by an authorized person, if the applicant entity is a limited liability company or limited partnership. If you have any questions, please call us at (401) 222-3040, Monday through Friday, between 8:30 a.m. and 4:30 p.m.

Instructions/Form 625 Revised: 12/05

Filing Fee: $50.00

ID Number:

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Office of the Secretary of State Corporations Division 148 W. River Street Providence, Rhode Island 02904-2615

STATEMENT OF ABANDONMENT OF USE OF FICTITIOUS BUSINESS NAME
Pursuant to the provisions of Section 7-1.2-402, 7-16-9 or 7-13-2 of the General Laws of Rhode Island, 1956, as amended, the undersigned business corporation, limited liability company or limited partnership hereby abandons the use of a fictitious business name in the transaction of business in the state of Rhode Island and submits the following: 1. The legal name of the applicant business corporation, limited liability company, or limited partnership is:

2. The fictitious business name being abandoned is 3. The date when the original fictitious business name statement was filed is 4. The state or territory under the laws of which it is incorporated, organized or formed is 5. The date of incorporation, organization or formation is 6. If a business corporation, the address of the registered office within Rhode Island is

Under penalty of perjury, I declare that the information contained herein is true and correct. Date:
Name of Applicant Corporation, Limited Liability Company or Limited Partnership

By
Signature of Authorized Officer of the Corporation or

By
Signature of Authorized Person for the Limited Liability Company or

By
Signature of Authorized Person for the Limited Partnership

Form No. 625 Revised: 12/05