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DO NOT STAPLE Print Reset
FORM IllinoisUniformPartnershipAct F ILE#
UPA-Withdrawal StatementofWithdrawalof T hisspaceforuseby
SecretaryofState.
(1001(e)/1102(f)) LimitedLiabilityPartnershipStatus
SecretaryofState
DepartmentofBusinessServices SubmitinDuplicate
LimitedLiabilityDivision
501S.SecondSt.,Rm.357
Springfield,IL62756 ThisspaceforusebySecretaryofState.
217-785-8960
www.cyberdriveillinois.com Date:
Paymentmustbemadebycertifiedcheck, AssignedFile#:
cashier’scheck,Illinoisattorney’scheck, FilingFee: $100
IllinoisC.P.A.’scheckormoneyorder
payabletoSecretaryofState. Approved:
1. LimitedLiabilityPartnershipName: __________________________________________________________
2. FederalEmployerIdentificationNumber(FEIN): ________________________________________________
3. StateofJurisdiction:______________________________________________________________________
4. EffectiveDateofInitialRegistrationinIllinois:__________________________________________________
5. StatusasaLimitedLiabilityPartnershipisvoluntarilywithdrawn.
6. AddressofChiefExecutiveOffice(P.O.Boxaloneandc/oareunacceptable.): ________________________
________________________________________________________________________________________
7. IllinoisRegisteredAgent:__________________________________________________________________
IllinoisRegisteredOffice(P.O.boxaloneandc/oareunacceptable.): ________________________________
______________________________________________________________________________________
8. Wedeclare,underthepenaltyofperjury,underthelawsoftheStateofIllinois,thattheforegoingistrue,
correctandcomplete.
Executed on the ___________of _______________ , ___________ by at least two partners.
Day Month Year
1. 1.
Signature StreetAddress
NameandTitle(typeorprint) City/Town
NameifaCorporationorotherEntity State,ZIP
2. 2.
Signature StreetAddress
NameandTitle(typeorprint) City/Town
NameifaCorporationorotherEntity State,ZIP
PrintedbyauthorityoftheStateofIllinois.May2009–200–RLLP4.4
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