Request For Cancellation Of Assumed Name - Minnesota Secretary Of State - 2007
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MINNESOTA SECRETARY OF STATE
Once your form is completed,
be sure to select "Print" at the
REQUEST FOR CANCELLATION
bottom of the screen to
capture your data entry for
OF ASSUMED NAME
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
READ THE INSTRUCTIONS BEFORE COMPLETING THIS FORM
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.
Print
FILE IN-PERSON OR MAIL TO:
Minnesota Secretary of State - Business Services
Reset
Retirement Systems of Minnesota Building
60 Empire Drive, Suite 100
St Paul, MN 55103
(Staffed 8:00 - 4:00, Monday - Friday, excluding holidays)
To obtain a copy of a form you can go to our web site at
, 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
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