Certificate Form Of Discontinuance Of Business
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1Certificate of Discontinuance of Business
Montgomery County Clerk’s Office, 64 Broadway, Fonda, NY 12068
Helen A. Bartone, Montgomery County Clerk (518) 853-8111
PURSUANT TO SECTION 130 OF THE GENERAL BUSINESS LAW OF NEW YORK STATE
I HEREBY CERTIFY that I/We have conducted or transacted business under the name of:
__________________________________________________ at _________________________________________________
(Business Name)
(Business Address)
In the County of Montgomery, State of New York and that a certificate of conducting business under an
assumed name was filed in the office of the County Clerk, County of Montgomery, State of New York,
on the _____ day of _____________ 20___ under instrument number _____________; and I hereby
further certify that the filing of a certificate in said County is no longer required for the reason that the
said business was discontinued on the ____ day of _____________ 20___ or the conditions under which
the business is conducted have changed so that the filing of a certificate in said County is no longer
required for the reason that ______________________________________________________________.
I thereof desire to file this certificate of discontinuance.
In Witness Whereof, I/We have this ____ day of ____________ 20___, made and signed this certificate
_______________________________
State of New York,
)
County of
) ss:
On this ______ day of _____________ 20___, before me, the undersigned, personally appeared
personally known to me or proved to be on basis of satisfactory evidence to be the individual(s) whose name(s) is
(are) subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her
capacity(ies), and that by his/her signature on the instrument, the individual or the person upon behalf of which the
individual acted, executed the instrument.
_______________________________
(Notary Public)
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