Cancellation Of Assumed Business Name {55339}

INSTRUCTIONS: 1. Use 8275224 x 11224 white paper for attachments. 2. Please TYPE or PRINT in INK. 3. Please visit our office on the web at www.sos.IN.gov 4. Submit original completed paperwork to: 302 West Washington Street, Room E-018, Indianapolis, IN 46204. NOTE: This form can only be used to cancel one assumed business name. Please submit a separate form and fee for each assumed business name to be cancelled. (SOS use only) (If different from above 226 SOS use only) American LegalNet, Inc. www.FormsWorkFlow.com (month, day, year) (number and street) (month, day, year) American LegalNet, Inc. www.FormsWorkFlow.com