Last updated: 4/18/2019
Statement Of Dissociation
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Description
Instructions:File with the Arkansas Secretary of State's Business Services Division, State Capitol, Little Rock, Arkansas 72201-1094with payment of fees. Acopy will be returned to the partnership at the listed address.PLEASE TYPE OR CLEARLYPRINTIN INKSTATEMENT OF DISSOCIATIONThe undersigned, pursuant to Act 1518 of 1999, sets forth the following:Name of Partnership:Name of Dissociated Partner:Mailing Address of Dissociated Partner:Effective Date of Dissociation:I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of Stateis a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.Authorizing Offficer (Type or Print)Authorized SignatureFiling Fee $15.00 payable to Arkansas Secretary of State Rev. 001027021n024030n030007r013027r031n027035025016007031n031r007031n031r003n026020031025022"004020031031022r006025013021037001027021n024030n030*%%#$!$#,'002032030020024r030030036003025023023r027013020n022007r027033020013r030037%(#b020013031025027035002032020022f020024017037$'#$t 003n026020031025022037004020031031022r006025013021 American LegalNet, Inc. www.FormsWorkFlow.com
