For Office Use: Statement of Withdrawal From Partnership Operating Under a Fictitious Business Name Jesse Salinas, County Clerk/Recorder Yolo County Clerk/Recorder 625 Court Street, Rm#B01 Woodland, CA 95695 (530) 666-8130 FBN Number: Please Print or Type FEE PAID $________________ The following person(s) have withdrawn as a general partner(s) from the partnership operating under the Fictitious Business Name(s): located at: Street Address (No PO Box) City State Zip (of Principal Place of Business in California) The Full Name & Address (may substitute business address) of the person(s) withdrawing as a partner(s) include: 1. ______________________________ Full Name (Print or Type) 2. _______________________________ Full Name (Print or Type) ______________________________ Street Address _______________________________ Street Address ______________________________ City St Zip _______________________________ City St Zip ______________________________ Signature _______________________________ Signature 3. ______________________________ Full Name (Print or Type) 4. _______________________________ Full Name (Print or Type) ______________________________ Street Address _______________________________ Street Address ______________________________ City St Zip _______________________________ City St Zip ______________________________ Signature _______________________________ Signature If there are more than four persons, please attach additional sheets showing registrant information and signatures. The fictitious business name referred to above was filed in Yolo County on ___________________ "I declare that all information in this statement is true and correct. (A registrant who declares as true information which he or she knows to be false is guilty of a crime.) I hereby certify that this is a true copy of the original document on file in this office. This certification is true as long as there are no alterations to the document, AND as long as the document is sealed with a red seal. Filing Fee: $55.00 See additional information on back. State of California County of Yolo Jesse Salinas, County Clerk/Recorder Date: by: Deputy Clerk 4/8/2016 American LegalNet, Inc. www.FormsWorkFlow.com Phone No. ( ) _______________________ Information will be kept confidential INSTRUCTIONS for filing a Statement of Withdrawal From Partnership Operating Under a Fictitious Business Name The instructions below are not to be published (B&P Code, Section 17924) Section 17293 of the Business & Professions Code (a) Any person who is a general partner in a partnership that is or has been regularly transacting business under a fictitious business name may, upon withdrawing as a general partner, file a statement of withdrawal from the partnership operating under a 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. The statement shall include: (1) The fictitious business name of the partnership. The date on which the fictitious business name statement for partnership was filed (2) and the county where filed. The street address of its principal place of business in this state or, if it has no place (3) of business in this state, the street address of its principal place of business outside this state, if any. (4) The full name and address of the person withdrawing as a partner. The statement of withdrawal from the 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. 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 subdivisions (a) and (b) and the requirement of subdivision (c) is satisfied. (b) (c) (d) NO changes, additions or corrections may be made to this statement after it has been filed in the office of the county clerk. Copies will be provided for your record, for publication and for the bank American LegalNet, Inc. www.FormsWorkFlow.com