Statement Of Dissociation From A Partnership {UPA-115}

COMMONWEALTH OF VIRGINIA UPA-115 STATE CORPORATION COMMISSION (07/03) STATEMENT OF DISSOCIATION FROM A PARTNERSHIP The undersigned present(s) this statement of dissociation for filing p ursuant to 50-73.115 of the Code of Virginia. 1. The name of the partnership is: ________________________________________________________________________ . 2. The partnerships SCC ID number is __________________________________ ________. 3. The following partner, who is named as a partner in a filed statement of partnership authority or in a list maintained by an agent pursuant to 50-73.93 B of the C ode of Virginia, is dissociated from the partnership: ________________________________________________________________________ . 4. The purpose of this filing is: [CHECK ONE] o for the partnership to dissociate itself from the partner listed in para graph 3. OR o For the partner listed in paragraph 3 to dissociate from the partnership . The individual(s) executing this document personally declare(s) unde r penalty of perjury that the contents are accurate. If submitted on behalf of the partnership, the signature of at least two partners: ______________________________ __________________________ ______________ (signature) (printed name) (date)______________________________ __________________________ ______________ (signature) (printed name) (date)If submitted by a dissociating partner, the signature of the dissociatin g partner: ______________________________ __________________________ ______________ (signature) (printed name) (date) SEE INSTRUCTIONS ON THE REVERSE American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 INSTRUCTIONS The statement must be in the English language, typewritten or printed in black, legible and reproducible. See 50-73.83 of the Code of Virginia. The document must be presented on uniformly white, opaque paper, free of visible watermarks and background logos. You can download this form from our website at www.state.va.us/scc/division/clk/index.htm. A statement of dissociation for a partnership may be filed if the partne rship has filed with the State Corporation Commission a statement of partnership authority that has not been canceled. If this statement is submitted by the partnership, it must be signed by at least two partners. If this statement is submitted by a dissociating partner, it must be signed by t he dissociating partner. Each person signing this statement must set forth his printed name next to or beneath his signature. A person signing on behalf of a partner that is a business e ntity should set forth the business entitys name, his or her printed name, and the capacity in which he or she is signing on behalf of the business entity. The person who files this statement shall promptly send a copy of the st atement to every nonfiling partner and to any other person named as a partner in the statement. Se e 50-73.83 E of the Code of Virginia. A partner has the power to dissociate at any time, rightfully or wrongfu lly, by express will pursuant to subdivision 1 of 50-73.109 of the Code of Virginia. A statement of dissociation is a limitation on the authority of a dissoc iated partner for the purposes of subsections D and E of 50-73.93 of the Code of Virginia. For the purposes of subdivision A3 of 50-73.113 and subdivision B3 of 50.73.114 of the Code of Virginia, a person, not a partner is deemed to have notice of the dissoc iation 90 days after the statement of dissociation is filed. Submit the original, signed statement to the Clerk of the State Corporat ion Commission, P.O. Box st1197, Richmond, Virginia 23218-1197 (mailing address: 1300 East Main St reet, Tyler Building, 1 Floor, Richmond, Virginia 23219), along with a check for the filing fee in the amount of $25.00, payable to the State Corporation Commission. PLEASE DO NOT SEND CASH . If you have any questions, please call (804) 371-9733 or toll-free in Virginia, 1-866- 722-2551. American LegalNet, Inc. www.USCourtForms.com