Free Statement of Denial - Illinois

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FORM UPA-304
January 2008

Illinois Uniform Partnership Act
Statement of Denial
Submit in duplicate. Please type or print clearly.

This space for use by Secretary of State.

Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 357 Springfield, IL 62756 217-785-8960 www.cyberdriveillinois.com

Payment must be made by certified check, cashier's check, money order, Illinois attorney's check or Illinois C.P.A.'s check. This space for use by Secretary of State. Date: Assigned File #: Filing Fee: $25 Approved:

1. Partnership Name: 2. File Number: 3. Fact of Denial:

(Name must be stated exactly as on record with the Secretary of State.)

Federal Employer Identification Number:

I/We declare, 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 two partners.

Signature

Number, Street Address

Name and Title (type or print)

City, State, ZIP

Signature

Number, Street Address

Name and Title (type or print)

City, State, ZIP

Please submit this form in duplicate along with $25 filing fee.
Signatures must be in black ink on an original document. Carbon copy, photocopy or rubber stamp signatures may only be used on conformed copies.
Printed by authority of the State of Illinois. January 2008 ­ 200 ­ UPA 9.2