Statement Of Dissolution {UPA-805}

FORM Payment may be made by check payable to Secretary of State. If check is returned for any reason this filing will be void. 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 October 2014 UPA-805 Illinois Uniform Partnership Act Statement of Dissolution SUBMITINDUPLICATE Type or Print Clearly. $100 FILE #: This space for use by Secretary of State. Filing Fee: Approved: 1. Partnership Name: (Name must be stated exactly as on record with the Secretary of State.) 2. Check one: Partnership or Limited Liability Partnership 3. Federal Employer Identification Number: 4. The above-named partnership has dissolved and is winding up its business. 5. This Statement of Dissolution cancels the Statement of Partnership Authority in accordance with Section 303(d)and 303(e). Date the Statement of Partnership Authority was filed with the Office of the Secretary of State: Month/Day/Year The undersigned declares, under the penalty of perjury, under the laws of the State of Illinois, that the foregoing is true, correct and complete. Executed on the Day of Month , Year by a partner. Signature Number, Street Address Name and Title (type or print) City, State, Zip Printed by authority of the State of Illinois. December 2014- 1 - UPA 11.4 American LegalNet, Inc. www.FormsWorkFlow.com