SECTIONS 1 THROUGH 4: I (we) the undersigned, hereby cancel the fictitious name which was registered on and was assigned registration number S.prIMJrrr or 'Dann DS S9.waw Ors ear Mark oho applicable boxes nCerldimno or Status — S10 0 Certified Copy— $30 NON-REFUNDABLE PROCESSING FEE: $S0 /LPN