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Agents To Be Canceled (Without Clear Records) S.D.4.C. - Virginia
| Agents To Be Canceled (Without Clear Records) 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.C. EXHIBIT III (Revised 1974) COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION DIVISION OF SECURITIES AND RETAIL FRANCHISING AGENTS TO BE CANCELED (Without Clear Records) (Detailed information attached herewith) NAME ADDRESS The information contained herewith is true to the best of this firms knowledge and belief. _________________________________________________ Broker-Dealer Date _________________________________________________ By (Signature) Title American LegalNet, Inc. www.USCourtForms.com
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