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This form may be used to draft your Certificate of Termination of Assumed Name. A document required or permitted to be filed.The assumed corporate name to be cancelled is:. To cancel a Business Name Registration (DBA) a letter of cancellation must be presented to the division. This is a request to cancel the Certificate of Assumed Name currently on record with the Office of the. Secretary of State. 1. NOTE: This form can only be used to cancel one assumed business name. Please submit a separate form and fee for each assumed business name to be cancelled. This form has been drafted for filing with the secretary of state. Please print or type.