Kentucky Secretary of State TREY GRAYSON
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Division of Corporations BUSINESS FILINGS P.O. Box 718 Frankfort, KY 40602 (502) 564-2848 http://www.sos.ky.gov/
Statement of Dissociation
SDS
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1.
Name of the partnership (name must match the name on record with the Secretary of State).
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2.
Partner dissociated from the partnership:
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3.
The dissociation was effective on: __________________________________________ (Day/Month/Year)
I/We declare the above-named partner to be dissociated from the general partnership. I/We declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct. Executed on _____________________________ (Day/Month/Year)
If filed by a dissociating partner, the dissociating partner must sign.
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(Signature)
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(Print of Type Name)
If filed by the partnership, two partners must sign.
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(Signature)
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(Signature)
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(Print of Type Name)
(Print of Type Name)
Instructions: Submit this form with one (1) exact or conformed copy. The filing fee is $20.00. Please make check payable to the "Kentucky State Treasurer." All information must be completed or this document will not be accepted for filing.
SDS (07/2006)