Form No. 625 - Statement Of Abandonment Of Use Of Fictitious Business Name Page 2
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2Filing Fee: $50.00
ID Number:
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Office of the Secretary of State
Corporations Division
148 W. River Street
Providence, Rhode Island 02904-2615
STATEMENT OF ABANDONMENT OF
USE OF FICTITIOUS BUSINESS NAME
Pursuant to the provisions of Section 7-1.2-402, 7-16-9 or 7-13-2 of the General Laws of Rhode Island, 1956, as
amended, the undersigned business corporation, limited liability company or limited partnership hereby abandons the use
of a fictitious business name in the transaction of business in the state of Rhode Island and submits the following:
1. The legal name of the applicant business corporation, limited liability company, or limited partnership is:
2. The fictitious business name being abandoned is
3. The date when the original fictitious business name statement was filed is
4. The state or territory under the laws of which it is incorporated, organized or formed is
5. The date of incorporation, organization or formation is
6. If a business corporation, the address of the registered office within Rhode Island is
Under penalty of perjury, I declare that the information contained
herein is true and correct.
Date:
Name of Applicant Corporation, Limited Liability Company or Limited Partnership
By
Signature of Authorized Officer of the Corporation
or
By
Signature of Authorized Person for the Limited Liability Company
or
By
Signature of Authorized Person for the Limited Partnership
Form No. 625
Revised: 12/05
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