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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
NOTICE OF CANCELLATION OF APPROVED CORPORATION
NAME RESERVATION OR NAME REGISTRATION
Read the Instructions
C009i
1. WHAT ARE YOU CANCELLING?
NAME RESERVATION
NAME REGISTRATION
2. NAME THAT WAS RESERVED OR REGISTERED - enter the exact name:
_______________________________________________________________________
3. A.C.C. FILE NUMBER: ___________________________________________________________
Find the A.C.C. file number on the upper corner of filed documents OR on our website at:
List the name
4. NAME RESERVATION:
of the OWNER of the reserved name – this is the individual or
entity listed as the Applicant in the Application to Reserve Corporation Name
or the individual or entity to whom the reservation was transferred
(Transferee) if a Notice of Transfer was filed:
_____________________________________________________
5. NAME REGISTRATION: List
the name of the foreign corporation that submitted the Application
For Registration of Corporation Name:
_____________________________________________________
SIGNATURE:
By my signature appearing below, I am requesting cancellation of the name
reservation or name registration listed in number 1 above.
By checking the box marked "I accept" below, I acknowledge under penalty of
perjury that this document together with any attachments is submitted in
compliance with Arizona law.
I ACCEPT
Signature
Printed Name
Date (mm/dd/yyyy)
REQUIRED - COMPLETE A OR B, BUT NOT BOTH– check only one box:
A. FOR CANCELING NAME RESERVATION:
B. FOR CANCELING NAME REGISTRATION:
I am the individual Owner (you are signing as
I am the Chairman of the Board of Directors of
an individual person, not for an entity).
the corporation filing this Notice.
I am a duly authorized Officer of the corporation
The Owner is an entity, and I am its duly
authorized agent.
filing this Notice.
I am a duly authorized bankruptcy trustee,
receiver, or other court-appointed fiduciary for
the corporation filing this document.
Mail:
Arizona Corporation Commission
Filing Fee: None (regular processing).
Corporate Filings Section
Expedited processing – add $35.00 to filing fee.
1300 W. Washington St., Phoenix, Arizona 85007
All fees are nonrefundable - see Instructions.
Fax:
602-542-4100
Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain
to the individual needs of your business.
All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.
If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.
C009.001
Arizona Corporation Commission – Corporations Division
Rev: 2010
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