WITHDRAWAL FORM with comments and instructions
FORM - TNW12 THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF CORPORATIONS AND TRADEMARKS WITHDRAWAL OF A TRADE NAME TRADE NAME TO BE WITHDRAWN _______________________________________________________ REGISTRATION NUMBER ____________________________________ DATE OF ORIGINAL REGISTRATION ____________________________________ THE TRADE NAME IS REGISTERED (please select one) – ___ AS A SOLE PROPRIETORSHIP/PARTNERSHIP _______________________________________________________________________ _______________________________________________________________________ __________________________________________________________________ ___ UNDER A FOREIGN/DOMESTIC CORPORATION __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ UNDER A FOREIGN/DOMESTIC LIMITED LIABILITY CO. …
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FORM - TNW12 THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF CORPORATIONS AND TRADEMARKS WITHDRAWAL OF A TRADE NAME TRADE NAME TO BE WITHDRAWN _______________________________________________________ REGISTRATION NUMBER ____________________________________ DATE OF ORIGINAL REGISTRATION ____________________________________ THE TRADE NAME IS REGISTERED (please select one) – ___ AS A SOLE PROPRIETORSHIP/PARTNERSHIP _______________________________________________________________________ _______________________________________________________________________ __________________________________________________________________ ___ UNDER A FOREIGN/DOMESTIC CORPORATION __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ UNDER A FOREIGN/DOMESTIC LIMITED LIABILITY CO. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ UNDER A LIMITED LIABLITY PARTNERSHIP __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ UNDER A LIMITED LIABILITY LIMITED PARTNERSHIP __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ UNDER A LIMITED PARTNERSHIP __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___ AS A NON PROFIT CORPORATION __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ______________________________________________________ _______________________________________________________ FIRST NAME LAST NAME MAILING ADDRESS ______________________________________________________ _______________________________________________________ TITLE CITY ISLAND ZIP CODE ______________________________________________________ _______________________________________________________ SIGNATURE EMAIL ADDRESS ______________________________________________________ _______________________________________________________ FIRST NAME LAST NAME MAILING ADDRESS ______________________________________________________ _______________________________________________________ TITLE CITY ISLAND ZIP CODE ______________________________________________________ _______________________________________________________ SIGNATURE EMAIL ADDRESS ACKNOWLEDGEMENT SUBSCRIBED AND SWORN TO BEFORE ME THIS _______ DAY OF ____________________________________________, 20_____________. ___________________________________________ NOTARY PUBLIC MY COMMISSION EXPIRES: __________________ NOTARY NUMBER: __________________ FOR OFFICIAL USE ONLY DATE RECEIVED RECEIVED BY PAYMENT RECEIVED PAYMENT TYPE RECEPIT NO. I DECLARE, UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE UNITED STATES VIRGIN ISLANDS, THAT I AM DULY AUTHORIZED TO CONDUCT THIS TRANSACTION ON BEHALF OF THE ENTITY LISTED ABOVE AND THAT ALL STATEMENTS CONTAINED IN THIS APPLICATION, AND ANY ACCOMPANYING DOCUMENTS, ARE TRUE AND CORRECT, WITH FULL KNOWLEDGE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE SUBJECT TO INVESTIGATION AND THAT ANY FALSE OR DISHONEST ANSWER TO ANY QUESTION MAY BE GROUNDS FOR DENIAL OR SUBSEQUENT REVOCATION OF REGISTRATION. PROVIDE NAME AND BUSINESS ADDRESS OF ENTITY EACH OF THE UNDERSIGNED HAS, THIS DAY, WITHDRAWN FROM, DISPOSED OF THIS INTEREST IN THE ABOVE MENTIONED BUSINESS AND IS NO LONGER CONNECTED WITH THE SAME AND WILL NOT BE RESPONSIBLE FOR DEBTS CONTRACTED BY SAID BUSINESS AFTER FILING OF THE WITHDRAWAL NOTICE, AS PRESCRIBED BY LAW. AFFIX CORPORATE SEAL HERE Comment [t1]: Trade name being withdrawn/canceled. Comment [t2]: Registration number, as provided by Corporations and Trademarks. Comment [t3]: Date of initial registration. Comment [t4]: Please tick the appropriate entity type and provide the actual entity name and business address. Comment [t5]: For corporations, the corporate seal MUST be affixed. Comment [t6]: Name, title, address, signature and email address of the person executing the withdrawal. The person executing this document must be authorized to do so.