Fill and Sign the Concord Tel Form

Form No. TN-7 5/07 RSA 349:2 TN-7 V-l.0 State of New Hampshire Department of State Corporate Division Concord Tel. 603-271-3244 Location: State House Annex - 3rd floor Mailing Address: Corporate Division, Department of State 107 North Main St., Concord, NH 03301-4989 CERTIFICATE OF WITHDRAWAL IN MEMBERS USING TRADE NAME Be it known that: (PLEASE TYPE OR PRINT CLEARLY ) Name of Owner(s) Withdrawing No. & Street City/Town State Zip doing business under the trade name (Business Name) at ( Business Address ) (No.) (Street) (City/Town) (State) (Zip) has/have withdrawn from said trade name effective (date) . The owners now comprising the trade name are (if more space is needed, attach additional sheet[s]): Name of Owners No. & Street City/Town State Zip Signed: (must be signed by all withdrawing and remaining owners ) Signature Print or type name Signature Print or type name Signature Print or type name Signature Print or type name Signature Print or type name Signature Print or type name DISCLAIMER: All documents filed with the Corporate Division will be publicly available for inspection physically, electronically or in other media. FEE: $10.00 Payable To: State of New Ham pshire HELP LINE TDD ACCESS: RELAY NH 1-800-735-2964