Form Nr-4 - Certificate Of Withdrawal Of Trade Name 2013
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1Natalie E. Tennant
Penney Barker, Manager
Secretary of State
Corporations Division
1900 Kanawha Blvd E.
Tel: (304)558-8000
Bldg 1, Suite 157-K
Fax: (304)558-8381
Charleston, WV 25305
Website:
E-mail:
CERTIFICATE OF
FILE ONE ORIGINAL
WITHDRAWAL OF
Office Hrs: Monday - Friday
(Two if you want a filed
8:30 a.m. – 5:00 p.m. ET
stamped copy returned to you)
TRADE NAME
FEE: $25.00
1. The name of the company to which
the Trade Name is registered to is:
__________________________________________
__________________________________________
and is organized in the State of:
__________________________________________
Date the Trade Name was filed with
the WV Secretary of State’s Office:
__________________________________________
2. The Trade Name being withdrawn is:
__________________________________________
3. The address of the principal office of the
entity transacting business is:
__________________________________________
__________________________________________
The name, title, address and
_____________________________________
4.
Name:
signature of the person having
authority to complete the
_____________________________________
Title:
application:
Street:
___________________________________________
City/State/Zip: ___________________________________________
5. Signature (See below *Important Legal Notice Regarding Signature):
_____________________________
________________________________________________
Signature
Date
*Important Legal Notice Regarding Signature:
Corporations/Voluntary Associations/Business Trusts/Unincorporated Nonprofit Associations/Limited
Partnerships -
Per West Virginia Code §31D-1-129. Penalty for signing false document. Any person who signs a document
he or she knows is false in any material respect and knows that the document is to be delivered to the Secretary of State for filing
is guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than one thousand dollars or confined in the
county or regional jail not more than one year, or both. Limited Liability Companies/Limited Liability Partnerships - Per
West Virginia Code §31B-2-209. Liability for false statement in filed record. If a record authorized or required to be filed
under this chapter contains a false statement, one who suffers loss by reliance on the statement may recover damages for the loss
from a person who signed the record or caused another to sign it on the person's behalf and knew the statement to be false at the
time the record was signed.
Form NR-4
Issued by the Office of the Secretary of State
Revised 4/13
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