Certificate of Discontinuance of Business
The undersigned hereby certify that I have conducted or transacted business under the name of:
at this location:
The original certificate was filed in the office of the Oneida County Clerk, State of New York, on:
_____________ under the index number ______________; that the last amended certificate was filed
on: _____________ in the office of said County Clerk under index number ______________. And I
hereby certify that the filing of a certificate in said County is no longer required for the reason that the
said business was discontinued on: _____________________ , 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 therefore desire to file this certificate of discontinuance.
In Witness whereof, I have this date ________________ made and signed this certificate (if partners –
all must sign):
_________________________________________
____________________________________
(print name)
(signature)
_________________________________________
____________________________________
(print name)
(signature)
_________________________________________
____________________________________
(print name)
(signature)
State of New York
County of Oneida
On the __________ day of _______________ in the year_________
_______________________________________________________
(Notary or Commissioner of Deeds signature)
Before me the undersigned, a Notary Public/Commissioner of Deeds in and for said State, personally appeared, personally known to me, or
proved to me on the basis of satisfactory evidence to be the individual(s) whose name is (are) subscribed to be within instrument and
acknowledge to me that he/she/they executed the same in his/her/their capacity(ies) and that by his/her/their signature(s) on the instrument, the
individual(s), or person upon behalf of which the individual(s) acted, executed the instrument.
updated 6/05
For county use only
(bar code label)