275-321B [Rev. 10/18] MELISSA WILK, Alameda County Clerk-Recorder 1106 Madison Street, Oakland, CA 94607 Telephone: (510) 272-6362 Website: www.acgov.org STATEMENT OF WITHDRAWAL OF PARTNERSHIP OPERATING UNDER FICTITIOUS BUSINESS NAME TYPE OR PRINT LEGIBLY AND FIRMLY IN BLACK OR DARK BLUE INK ONLY *Original File Number **THE FOLLOWING PERSON(S) HAS/HAVE WITHDRAWN AS A GENERAL PARTNER(S) FROM THE PARTNERSHIP OPERATING UNDER THE FICTITIOUS BUSINESS NAME: (Please Print or Type) T h e F ict i ti o u s Bu si n e ss N a m e Statement for the Partnership filed on in the County of Alameda . FBN Filed Date F i c ti t i o u s B u s in e ss N a m e(s) (as filed) Ad dr e s s o f P r i n c ip a l pl ac e o f b u s i n e s s (as filed) C ity S t a te Z ip C o u n t y ***THE FULL NAME(S) AND RESIDENCE ADDRESS(ES) OF THE WITHDRAWING PARTNER(S): (If more than four owners, attach the Additional Information Form showing owner information) I declare that all information in this statement is true and correct. A registrant who declares as true any material matter pursuant to this section that the registrant knows to be false is guilty of a misdemeanor punishable by a fine not to exceed one thousand dollars ($1,000). Registrant (Print name)Title (If Corporation, print title of officer. If LLC, print title of officer or manager.) ****Registrant Signature This statement was filed with the Clerk-Recorder of Alameda County on the date indicated by the filing stamp in the upper right hand corner. White - Yellow Copy - Bank & other Required Needs (Certified) Pink Copy - Newspaper Copy Goldenrod Copy - 2. Full Name of Withdrawing Partner (as filed) Residence Address (P.O. Box not accepted) C it y S t a t e Z i p If Corporation or LLC Print State of Incorporation/Organization 1 . Full Name of Withdrawing Partner (as filed) Residence Address (P.O. Box not accepted) C it y S t a t e Z i p If Corporation or LLC Print State of Incorporation/Organization 3. Full Name of Withdrawing Partner (as filed) Residence Address (P.O. Box not accepted) C it y S t a t e Z i p If Corporation or LLC Print State of Incorporation/Organization 4. Full Name of Withdrawing Partner (as filed) Residence Address (P.O. Box not accepted) C it y S t a t e Z i p If Corporation or LLC Print State of Incorporation/Organization American LegalNet, Inc. www.FormsWorkFlow.com 275-321B [Rev. 10/18] INSTRUCTIONS FOR COMPLETION OF STATEMENT THE INFORMATION BELOW IS NOT TO BE PUBLISHED (SEC. 17924, B&P) REQUIREMENTS FOR FILING THE WITHDRAWAL (Sec. 17923 B&P Code) 1. Any person who is a general partner in a partnership that is or has been regularly transacting business using a fictitious business name may, upon withdrawing as a general partner, file a statement of withdrawal from partnership operating under fictitious business name. The statement shall be executed by the person filing the statement in the same manner as a fictitious business name statement and shall be filed with the County Clerk of the county where the partnership filed its fictitious business name statement. 2. Unless a notice of the dissolution of the partnership has been published pursuant to Section 15035.5 of the Corporation Code, the statement of withdrawal from partnership operating under a fictitious business name shall be published in the same manner as the fictitious business name statement and an affidavit showing the publication of the statement shall be filed with the county clerk after the completion of the publication. 3. The withdrawal of a general partner does not cause a fictitious business name statement to expire if the withdrawing partner files a statement of withdrawal in accordance with (1) above, these instructions, and if the publication requirement of (2) above is satisfied. INSTRUCTIONS FOR COMPLETING THE WITHDRAWAL (Sec. 17922 B&P Code) Type or print legibly and firmly in black ink. * Insert the Original File Number where indicated on form. ** Insert the date on which the fictitious business name statement relating to the withdrawing partner was filed. Insert the fictitious business name of the partnership from which the partner is withdrawing. This name(s) must be the exact name(s) as shown on the fictitious business name statement. More than one business name may be listed on the withdrawal form ONLY if all the names were originally listed on the same FBN statement form. If more than one name is listed number each name; the Additional Information Form may be used to list additional names. Insert the street address of the principal place of business as filed. (P.O. Box, postal drop box, mailing suite, or c/o addresses are not acceptable.) If there is no place of business in California, insert the street address of the principal place of business outside of California. *** Insert the full name and residence address of each registrant withdrawing as a partner, as filed on the original FBN statement. (P.O. Box, postal drop box, mailing suite, or c/o addresses are not acceptable.) **** The withdrawing partner must sign. If more than one withdrawing partner files on the same withdrawal form, each must sign. NOTICE TO REGISTRANT (Sec. 17924 B&P Code) Within 30 days after the statement of withdrawal has been filed with the County Clerk, the statement must be published in a newspaper of general circulation in the county where the principal place of business is located. The newspaper selected should be one that circulates in the area where the business was conducted. The statement must be published once a week for four successive weeks with five days between each date of publication. An affidavit of publication must be filed with the County Clerk within 30 days after the completion of publication. (Sec. 17917 B&P Code, Sec. 6064 Gov. Code) American LegalNet, Inc. www.FormsWorkFlow.com