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Agents To Be Canceled (Records Clear) S.D.4.B. - Virginia

Agents To Be Canceled (Records Clear) Form. This is a Virginia form and can be used in Securities And Franchising Blue Sky Secretary Of State .
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S.D.4.B. EXHIBIT II (Revised 1974) COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION DIVISION OF SECURITIES AND RETAIL FRANCHISING AGENTS TO BE CANCELED (Records Clear) (A separate sheet may be attached if necessary) NAME ADDRESS To the best of this firms knowledge, the record of each of these ind ividuals is clear. _________________________________________________ Broker-Dealer Date _________________________________________________ By (Signature) Title American LegalNet, Inc. www.USCourtForms.com
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