Form Upa-Withdrawal (1001(E)/1102(F)) - Illinois Uniform Partnership Act Statement Of Withdrawal - Illinois Secretary Of State

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DO NOT STAPLE
FILE #
FORM
Illinois Uniform Partnership Act
This space for use by
UPA-Withdrawal
Secretary of State.
Statement of Withdrawal of
Limited Liability Partnership Status
(1001(e)/1102(f))
Secretary of State
Department of Business Services
Submit in Duplicate
Limited Liability Division
501 S. Second St., Rm. 357
Springfield, IL 62756
This space for use by Secretary of State.
217-785-8960
Date:
Assigned File #:
Payment must be made by certified check,
cashier’s check, Illinois attorney’s check,
Filing Fee: $100
Illinois C.P.A.’s check or money order
Approved:
payable to 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 Status as a Limited Liability Partnership is voluntarily withdrawn.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.
1.
Signature
Street Address
Name and Title (type or print)
City/Town
Name if a Corporation or other Entity
State, ZIP
2.
2.
Signature
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

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