Form Wtdrw_true - Statement Of Change Withdrawing A Registration Of True Name - 2009

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ABOVE SPACE FOR OFFICE USE ONLY
Statement of Change Withdrawing a Registration of True Name
§7- 90-604
filed pursuant to
§7-90-305.5
and
of the Colorado Revised Statutes (C.R.S)
1. The ID number and the true name are
ID number
_________________________
(Colorado Secretary of State ID number)
True name
______________________________________________________.
2. The registration of true name is relinquished.
3.
(If applicable, adopt the following statement by marking the box and include an attachment.)
This document contains additional information as provided by law.
4.
(Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has
significant legal consequences. Read instructions before entering a date.)
(If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required format.)
The delayed effective date and, if applicable, time of this document is/are __________________________.
(mm/dd/yyyy hour:minute am/pm)
Notice:
Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that such document is
such individual's act and deed, or that such individual in good faith believes such document is the act and deed
of the person on whose behalf such individual is causing such document to be delivered for filing, taken in
conformity with the requirements of part 3 of article 90 of title 7, C.R.S., and, if applicable, the constituent
documents and the organic statutes, and that such individual in good faith believes the facts stated in such
document are true and such document complies with the requirements of that Part, the constituent documents,
and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the Secretary of
State, whether or not such individual is identified in this document as one who has caused it to be delivered.
WTDRW_TRUE
Page 1 of 2
Rev. 12/01/2009

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