Secretary of State 
                                                                                     Business Programs Division 
                                                                                                Business Entities 
                                                                           1500 11th Street, Sacramento, CA 95814 
                                                                    P.O. Box 944260, Sacramento, CA 94244-2600 

                                    Business Entities Submission Cover Sheet

                                For faste stservice, file online at      bizfileOnline.sos.ca.gov. 

Instructions: 

• Complete and include this form with your paper submission. This form will not be made part of
  the filed document.

• Make all checks or money orders payable to the Secretary of State.

• In-person submissions (excluding Statements of Information): $15                      special handling fee  D. o not
  include                       a $15 special handling fee when submitting documents by mail.

• All submissions are reviewed in the date order of receipt ,                 with online submissions given priority.
  For updated processing time information, visit www.sos.ca.gov/business/be/processing-dates.

•    obtainTo a certified copy,               includ ecertification fees with your submission.

                                Note: All correspondence related to your submission will be 
                                sent to the name and address on your check or money order.

Contact Person                        (Please type or print legibly): 

First Name:                                                      Last Name: 

Phone Number:                                                   Email:

Entity Information (Please type or print legibly): 

Entity Name:  

Entity Number (if applicable): 

Comments: 

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Submission Cover Sheet (REV 03/2024) 

  Instructions for Completing the Statement of Dissociation (FORM GP-3) 

Legal Authority: Statutory filing provisions are found in California Corporations Code section 16704.  
All statutory references are to the California Corporations Code, unless otherwise indicated. 

• A Statement of Partnership Authority (Form GP-1) must be filed with the Secretary of State of California
  prior to filing a Statement of Dissociation (Form GP-3).

• A dissociated partner or the partnership may file a Statement of Dissociation (Form GP-3) stating that
  a partner is dissociated.

Fees: The fee for filing Form GP-3 is $30.00. A non-refundable $15.00 handling fee is applicable for 
processing documents delivered in person (drop off) at the Sacramento office. 

Copies: Upon filing, we will return one (1) plain copy of your filed document for free, and will certify the 
copy upon request and payment of an additional $5 certification fee.   

Complete the Statement of Dissociation (Form GP-3) as follows: 

Item 1.      Enter the name of the partnership as filed with the Secretary of State of California. 

Item 2.      Enter the entity number issued to the partnership by the Secretary of State of California. 

Item 3.      Enter the name of the dissociated partner. 

Item 4.      Enter a statement that the partner is dissociated from the partnership. Attach additional pages, 
             if necessary, and indicate the number of pages attached in Item 5.   

Item 5.  Enter the number of pages attached, if any. 

Item 6.      A Statement of Dissociation (Form GP-3) filed by a dissociated partner shall be executed with 
             the original signature of the dissociated partner.  A Statement of Dissociation (Form GP-3) filed 
             by a partnership shall be executed with the original signatures of at least two partners. 
             (Section 16105(c).)   

Item 7.  Enter the name and mailing address of the person or firm to whom a copy of the filing is to be 
             returned. 

GP-3  (REV 03/2022)                                                               2022 California Secretary of State 
                                                                                  bizfileOnline.sos.ca.gov

                                                   State of California                                             Form GP-3 
                                                       Secretary of State 

                                      STATEMENT OF DISSOCIATION 

                                      A $30.00 filing fee must accompany this form. 
                         IMPORTANT – Read instructions before completing this form. 

1.  NAME OF PARTNERSHIP:                                                              2. SECRETARY OF STATE ENTITY NUMBER:

3.  NAME OF DISSOCIATED PARTNER:

4.  STATEMENT THAT THE PARTNER IS DISSOCIATED FROM THE PARTNERSHIP (ATTACH ADDITIONAL PAGES IF NECESSARY):

5.  NUMBER OF PAGES ATTACHED ,IF ANY:
6.   I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT         THIS SPACE FOR FILING USE ONLY
    THE FOREGOING IS TRUE AND CORRECT.
                                                                                            DOCUMENT   #  

    SIGNATURE OF PARTNER                               DATE EXECUTED

    TYPE OR PRINT NAME OF PARTNER                      COUNTY AND STATE EXECUTED

    SIGNATURE OF PARTNER                               DATE EXECUTED

    TYPE OR PRINT NAME OF PARTNER                      COUNTY AND STATE EXECUTED
7.  RETURN TO:
    NAME:
    ADDRESS:
    CITY:                             STATE:           ZIP CODE: 

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