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APPLICATION FOR CANCELLATION OF ASSUMED CORPORATE NAME
Corporate Filings 312 Rosa L. Parks Avenue 6th Floor, William R. Snodgrass Tower Nashville, TN 37243

Pursuant to the provisions of Section 48-14-10l(e) of the Tennessee Business Corporation Act or Section 48-54-l01(e) of the Tennessee Nonprofit Corporation Act, the undersigned corporation hereby submits this application:

1. The true name of the corporation is:

2. The state or country of incorporation is:

3. The corporation intends to cease transacting business under an assumed corporate name by cancelling it.

4. The assumed corporate name to be cancelled is:

Signature Date

Name of Corporation

Signer's Capacity

Signature

Name (typed or printed)

SS-4405 (Rev. 6/00)

RDA 1678