Certificate Of Discontinuance Of Doing Business Under Assumed Name Form - Dutchess County
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1Certificate of DISCONTINUANCE of Doing Business
Under Assumed Name (Discontinuance of “D/B/A”)
Dutchess County Clerk’s Office, 22 Market Street, Poughkeepsie, NY 12601
Bradford H. Kendall, Dutchess County Clerk 845-486-2120
PURSUANT TO SECTION 130 OF THE GENERAL BUSINESS LAW OF NEW YORK STATE
I/We certify that I/we filed a Certificate of Doing Business Under Assumed Name (“DBA”) under the name:
________________________________________________________________________________________
located at the street address__________________________________________________________________
in the Dutchess County Clerk’s office on ______________(date) and numbered _______________________
[(Optional: and amended by a further filing on _____________________________________________(date)]
And hereby certify that I/we hereby DISCONTINUE the use of the previously filed Certificate (together with
any amendments) for that said business was discontinued on ______________________(date) or that other
conditions under which this business was conducted are no longer required for the following reason(s):
______________________________________________________________________________________
I/we therefore desire to file this Certificate of Discontinuance of Doing Business Under Assumed Name (“DBA”)
Signature:________________________________________________________ Date:_______________
Signature:________________________________________________________ Date:_______________
Signature:________________________________________________________ Date:_______________
Signature:________________________________________________________ Date:_______________
STATE OF NEW YORK
)
COUNTY OF DUTCHESS
) ss:
On this _______________ day of ________________, 20___, before me, the undersigned appeared
________________________________________________________________________
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) are subscribed to
the within instrument and who each acknowledged to me that he/she executed the same in his/her capacity and that by his/her
signature on the instrument, the individual(s), or the person(s) upon behalf of which individual(s) acted, executed the instrument.
________________________________________________________________________
(Signature and office of the individual taking acknowledgement- Notary Public)
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