Statement Of Amendment {UPA-1005-1106} pdf

Form UPA-1005 October 2014 Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 357 Springfield, IL 62756 217-524-8008 www.cyberdriveillinois.com / 1106 Resignation of Registered Agent Filing Fee: $25 Approved: SUBMITINDUPLICATE Type or print clearly. Illinois Uniform Partnership Act FILE # This space for use by Secretary of State. Payment may be made by check payable to Secretary of State. If check is returned for any reason this filing will be void. 1. Partnership Name: ______________________________________________________________________ 2. Federal Employer Identification Number (F.E.I.N): ______________________________________________ 3. Registered Agent's Name and Registered Address: Registered Agent: (P.O.Box alone or C/O is unacceptable.) First Name Middle Initial Street Last Name Suite# Registered Office: ______________________________________________________________________ ______________________________________________________________________ Number City Zip 4. Effective Date of Registration: o The agent resigns effective the 31st day after filing by the Secretary of State. o Another date not less than 30 days after the filing by the Secretary of State. The resigning agent has caused a copy of this notice to be sent by registered or certified mail to the Chief Executive Office of the Limited Liability Partnership at least 10 days prior to the date of its filing with the Secretary of State. Dated ______________________________ 20 Month, Day Year Signature of Registered Agent (See Note 2.) Name (type or print) ______________________________________________________________________ IL ______________ (See Note1.) 5. The undersigned declares, under penalties of perjury, that the facts stated herein are true. Dated Month, Day __________________________________ 20 Year Signature of Registered Agent (See Note 3.) Name (type or print) By ________________________________ ____________________________________ By ____________________________________ ________________________________________ NOTE: 1. Add additional time of mailing the form. 2. If registered agent is an individual, this notice shall be signed by the registered agent. 3. If registered agent is a corporation, this notice shall be signed by a principal officer. Printed by authority of the State of Illinois. November 2014 -- 1 -- UPA 18.1 American LegalNet, Inc. www.FormsWorkFlow.com