Request For Cancellation Of Reservation Of Name {DOS-2103-f}

New York State Department of State DIVISION OF CORPORATIONS, STATE RECORDS AND UNIFORM COMMERCIAL CODE One Commerce Plaza 99 Washington Ave.Albany, NY 12231-0001 www.dos.ny.gov Cancellation of Reservation of Name PLEASE TYPE OR PRINT Under 247303 of the Not-for-Profit Corporation Law APPLICANT222S NAME AND ADDRESS NAME RESERVED X Signature of applicant, applicant222s attorney or agent Typed/printed name of signer (If attorney or agent, so specify) INSTRUCTIONS: 1.The applicant must be the same applicant as stated in the Application for Reservation of Name.2.The name reserved must be stated exactly as in the original Application for Reservation of Name, includingspacing and punctuation. 3. Attach the original Certificate of Reservation or if a Extension of Reservation of Name was filed the new Certificate of Reservation, to this Cancellation of Reservation of Name. 4. This Cancellation of Reservation of Name must be filed the Department of State before the current reservation. 5. A $10 filing fee payable to the Department of State must accompany this Cancellation ofReservation of Name DOS-2103-f (Rev. 01/18) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com