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FORM UPA-805 Illinois
FILE #:
October 2020 Uniform Partnership Act This space for use by Secretary of State.
Statement of Dissolution
Secretary of State
Department of Business Services
Limited Liability Division SUBMITINDUPLICATE
501 S. Second St., Rm. 357 Type or print clearly.
Springfield, IL 62756
217-524-8008
www.cyberdriveillinois.com
Filing Fee: $100
Payment may be made by check Approved:
pay able to Secretary of State. If
check is returned for any reason
this filing will be void.
1. Partnership name:
(Name must be stated exactly as on record with the Secretary of State.)
2. Check one: ❏ Partnership or Limited❏ Liability Partnership
3. Federal Employer Identification Number (FEIN):
4. The above-named partnership has dissolved and is winding up its business.
5. If applicable, this Statement of Dissolution cancels any active Statement of Partnership Authority filed in
accordance with Section 303(d)and 303(e) filed:
Month/Day/Year
The undersigned declares, under the penalty of perjury, under the laws of the State of Illinois, that the foregoing
is true, correct and complete.
Executed on the of , by a partner.
Day Month Year
Signature Number, Street Address
Name and Title (type or print) City, State, ZIP
Printed by authority of the State of Illinois. November 2020 - 1 - UPA 11.5
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