Statement Of Dissociation {SS-9417}

Instructions: SS-9417 1 | Page Instructions: Form SS-9417 Statement of Dissociation from Limited Partnership Business Services Division Tre Hargett, Secretary of State State of Tennessee Submission Options A Statement of Dissociation from Limited Partnership form may be filed using one of the following methods: Paper submission: A blank Statement of Dissociation from Limited Partnership may be obtained by going to sos.tn.gov and entering SS-9417 in the search bar; by emailing the Secretary of State at TNSOS.CORPINFO@tn.gov, or by calling 615-741-2286 . The Statement of Dissociation from Limited Partnership form should be typed or hand printed in dark blue or black ink. Walk-in: A blank Statement of Dissociation from Limited Partnership form may be obtained in person at the address listed below. If submitting by mail, send the completed form and filing fee together in the same envelope. Mail to: Tennessee Secretary of State ATTN: Corporate Filing 312 Rosa L. Parks Ave FL 6 Nashville TN 37243 Fill in form very carefully; mistakes may have important legal consequences. If you have questions, consult your attorney. The filing office cannot provide legal advice. Completing the Form Pursuant to T.C.A. 247 61-3-601 or T.C.A. 247 61-3-603 of the Tennessee Uniform Limited Partnership Act of 2017, the Limited Partnership must submit the following to file a Statement of Dissociation from Limited Partnership: 1. Control Number: Enter the control number assigned to the Limited Partnership. To find entity information, including the Secretary of State control number, visit: https://tnbear.tn.gov/ECommerce/FilingSearch.aspx 2. Limited Partnership Name: Enter the exact, legal name of the Limited Partnership as listed on the records of the Tennessee Secretary of State. To find entity information, including the exact, legal name, visit: https://tnbear.tn.gov/ECommerce/FilingSearch.aspx . American LegalNet, Inc. www.FormsWorkFlow.com Instructions: SS-9417 2 | Page 3. This Dissociation is for a: Select if the partner dissociating is a limited partner or a general partner. 4. Effective Date: If the document is not to be effective upon filing by the Secretary of State, enter the delayed date. Note: The delayed date shall not be later than ninety (90) calendar days after the date the document is filed by the Secretary of State. Signature The Statement of Dissociation must be signed by the partner who is dissociating from the Limited Partnership. The person executing the document must sign and date the form in the appropriate spaces. Type or print the signature name and title of the signer. If the dissociating partner is unable to sign, fill in the reason and one of the remaining General Partners listed in the Certificate of Limited Partnership may sign in the appropriate space. Filing Fee The filing fee is $20.00 per Statement of Dissociation from Limited Partnership. Make check, cashier222s check or money order payable to the Tennessee Secretary of State. Cash is only accepted for walk-in filings. Requests submitted without the proper filing fee or made payable to an entity other than the Tennessee Secretary of State will be rejected. American LegalNet, Inc. www.FormsWorkFlow.com en-USPursuant to the Tennessee Uniform Limited Partnership Act of 2017, T.C.A. 247 61-3-601 or T.C.A. 247 en-US61-3-603, the following partner is dissociated from the Limited Partnership: en-US2. Limited Partnership Name: en-US3. This Statement Dissociation is for a:en-USLimited Partner en-USGeneral Partner en-US4. The name of the partner hereby dissociated from the partnership is: en-US5. þ en-USen-US en-USen-USthe Secretary of State.en-USSignature of partner dissociating from the Limited Partnership T.C.A. 247 61-3-203(a)(5)(c):en-USDateen-USSignature en-USTitle/Signer222s Capacity en-USPrinted Name en-USThis person is not able/required to sign because: en-USDateen-USSignature en-USTitle/Signer222s Capacity en-USPrinted Name en-USen-US(a)(5)(A) :en-USen-USen-USAll information on this form is public record. en-US(date: mm/dd/yy)en-US(time)en-US,en-US1. Control Number: Tre Hargett en-USSecretary of Stateen-USDivision of Business Servicesen-USDepartment of Stateen-USState of Tennesseeen-USATTN: Corporate Filingen-US312 Rosa L. Parks Ave, 6th FLen-USNashville, TN 37243-1102en-US(615) 741-2286en-USen-US en-USFiling Fee: $20.00 en-USSTATEMENT OF DISSOCIATION FROM LIMITED PARTNERSHIP en-USPhone #: () en-US-en-USSubmitter Name: American LegalNet, Inc. www.FormsWorkFlow.com