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Certificate of Discontinuance of Business The undersigned certify that they have conducted or transacted business under the name or designation of located at in the Street city state zip code City, Town, or Village of of Cayuga, State of New York and that (please circle one) a business certificate of assumed name was filed in the Cayuga County Clerk’s office on day document the last amended certificate was on the ____day under document number________; further certified that said business was discontinued on the or the conditions under which it was conducted have changed, so that the filed certificate is no longer required, for the reason: Therefore the undersigned desires to file this certificate of discontinuance. Print this day of 20___ Address Street city state zip code State of New York, County RPL309-a (Do not use outside New York State) On before me, the undersigned, personally Personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose names are subscribed to the within instrument & acknowledged to me that he/she/they executed the same in his/her/their capacity that by his/her/their signature(s) on the instrument, the individual(s) or the person on behalf of the individual(s) acted, executed the instrument Notary Public