Free Statement of Withdrawal of Limited Liability Partnership Status - Illinois

DO NOT STAPLE

Print

Reset

FORM UPA-Withdrawal (1001(e)/1102(f))
Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 357 Springfield, IL 62756 217-785-8960 www.cyberdriveillinois.com
Payment must be made by certified check, cashier's check, Illinois attorney's check, Illinois C.P.A.'s check or money order payable to Secretary of State.

Illinois Uniform Partnership Act
Statement of Withdrawal of Limited Liability Partnership Status
Submit in Duplicate
This space for use by Secretary of State. Date: Assigned File #: Filing Fee: $100 Approved:

FILE #

This space for use by Secretary of State.

1. Limited Liability Partnership Name: __________________________________________________________ 2. Federal Employer Identification Number (FEIN): ________________________________________________ 3. State of Jurisdiction: ______________________________________________________________________ 4. Effective Date of Initial Registration in Illinois:__________________________________________________ 5. Status as a Limited Liability Partnership is voluntarily withdrawn. 6. Address of Chief Executive Office (P.O. Box alone and c/o are unacceptable.): ________________________ ________________________________________________________________________________________ 7. Illinois Registered Agent: __________________________________________________________________ Illinois Registered Office (P.O. box alone and c/o are unacceptable.): ________________________________ ______________________________________________________________________________________ 8. We declare, 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 at least two partners.
Day Month Year

1.

Signature

1.

Street Address

Name and Title (type or print)

City/Town

Name if a Corporation or other Entity

State, ZIP

2.

Signature

2.

Street Address

Name and Title (type or print)

City/Town

Name if a Corporation or other Entity

State, ZIP

Printed by authority of the State of Illinois. May 2009 ­ 200 ­ RLLP 4.4