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2. AFFIDAVIT OF BUSINESS TERMINATION OR MOVE OR SALE OF BUSINESS OR PROPERTY

4. Business or Property Owner's Name*
6. Business Name (if applicable)
7. Street location (in Town)*

9. With regards to said business or property I do so certify that on

10. Date*
    Date
12. Said business or property was:*

    1. Sold to:
    2. Moved to:
    3. Terminated:
14. Name*
16. City/Town State where business or property was moved*
18. Address*
20. Attach Bill of Sale*
22. Attach Bill of Sale or Letter of Dissolution or Termination of Trade Name Certificate*
24. Electronic Signature*
25. Date Signed*
    Date Signed
27. Phone Number*
28. Fax Number
30. Email Address*
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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