Fill and Sign the Parks Group Print Ampamp Mail Services Form

Cancellation of Registration of Fictitious Name (No Fee Required) Registration Number of fictitious name, filed with our office, to be cancelled X ___________________________________________ Name of fictitious name, filed with our office, to be cancelled ________________________________________________________\ _ Business address of above listed fictitious name registration at time of filing to be cancelled _________________________________ ________________________________________________________________________\ ____________________________________ ________________________________________________________________________\ ____________________________________ Signature of at least one owner as listed on fictitious to be cancelled ________________________________________________________________________\ ____________________________________ Authorized Signature Printed Name Date ________________________________________________________________________\ ____________________________________ Authorized Signature Printed Name Date ________________________________________________________________________\ ____________________________________ Authorized Signature Printed Name Date State of Missouri Robin Carnahan, Secretary of State Corporations Division P.O. Box 778 / 600 W. Main Street, Rm 322 Jefferson City, MO 65102 MDCCCXX POPULISUPREMALEXESTO SALUSUNITEDWESTANDDIVIDEDWEFALL UNUMEPLURIBUS Corp. 14 (01/05) Name and address to return filed document: Name: _________________________________________ Address: _________________________________________ City, State, and Zip Code: __________________________ In Affirmation thereof, the facts stated above are true and correct : (The undersigned understands that false statements made in this filing are subject to the penalties provided under Section 575. 060 RSMo)