Free Fillable Certificate of Surrender of Authority Form - New York

New York State Department of State Division of Corporations, State Records One Commerce Plaza, 99 Washington Avenue and Uniform Commercial Code Albany, NY 12231 www.dos.state.ny.us

CERTIFICATE OF SURRENDER OF AUTHORITY OF
(Insert Name of Foreign Limited Partnership)

Under Section 121-905 of the Revised Limited Partnership Act

FIRST: The name of the limited partnership as it appears on the index of names in the
Department of State is: If applicable, the fictitious name the limited partnership has agreed to use in this state is:

SECOND: The jurisdiction where the limited partnership was organized is: THIRD: The date on which its application for authority to do business in this state was filed
with the Department of State is:

FOURTH: The limited partnership surrenders its authority do business in New York State. FIFTH: The limited partnership revokes the authority of its registered agent, if any, previously
designated, and, hereby consents that process against it in any action or special proceeding based upon any liability or obligation incurred by it within this state before the filing of the certificate of surrender may be served on the Secretary of State in the manner set forth in Section 121-109 of the Revised Limited Partnership Act.

SIXTH: The address to which the Secretary of State shall mail a copy of any process against the limited partnership is:

X

(Signature)

(Type or print name)

(Title of Signer)

DOS-1396 (Rev. 5/08)

-1-

CERTIFICATE OF SURRENDER OF AUTHORITY OF
(Insert Name of Foreign Limited Partnership)

Under Section 121-905 of the Revised Limited Partnership Act

Filed by:

(Name) (Mailing address) (City, State and Zip code)

NOTE: This form was prepared by the New York State Department of State for filing a certificate of surrender of authority for a foreign limited partnership. You are not required to use this form. You may draft your own form or use forms available at legal stationery stores. The Department of State recommends that legal documents be prepared under the guidance of an attorney. The certificate must be signed by a general partner, or by a trustee, receiver or other person authorized by law to wind up such limited partnership. This certificate must be accompanied by a fee of $60.
(For office use only)

-2-