275-321-B [Rev. / 0] PATRICK O’CONNELL, Alameda County Clerk-Recorder 1106 Madison Street, First Floor Oakland, CA 94607 Telephone (510) 272-6362 STATEMENT OF WITHDRAWAL FROM PARTNERSHIP OPERATING UNDER FICTITIOUS BUSINESS NAME PLEASE TYPE OR PRINT LEGIBLY/FIRMLYIN BLACK INK SEE REVERSE SIDE FOR INSTRUCTIONS Original File Number ___________________ THE FOLLOWING PERSON(S) HAS (HAVE) WITHDRAWN AS GENERAL PARTNER(S) FROM THE PARTNERSHIP UNDER: A FICTITIOUS BUSINESS NAME(S) * B Street Address of Principal place of Business (P.O. Box not acceptable ** City State Zip Mailing Address City State Zip C (Optional) The Fictitious business Name Statement for the Partnership was filed on ______________________ in the County of Alameda. (Date) D 1 2 Full Name of Withdrawing Partner Residence Street Address (P.O. Box not acceptable) Residence Street Address (P.O. Box not acceptable) City State City Zip Full Name of Withdrawing Partner 4 State Full Name of Withdrawing Partner City Zip State Zip (If a corporation, show state of incorporation) (If a corporation, show state of incorporation) E1 Zip Residence Street Address (P.O. Box not acceptable) Residence Street Address (P.O. Box not acceptable) City State (If a corporation, show state of incorporation) (If a corporation, show state of incorporation) 3 Full Name of Withdrawing Partner E2 This business was conducted by: If registrant is a corporation, officer signs below: Signed _______________________________________________ Corporation Name _______________________________________________ Signed _______________________________________________ Signature and Title _______________________________________________ Type or Print Name _________________________________________ Type or Print Officer’s Name _________________________________________ Type or Print Name _________________________________________ Type or Print Officer’s Name _________________________________________ THIS STATEMENT WAS FILED WITH THE COUNTY CLERK-RECORDER OF ALAMEDA COUNTY ON THE DATE INDICATED BY THE FILE STAMP ABOVE DISTRIBUTION: White – Clerk’s Copy Yellow – Registrant’s Copy American LegalNet, Inc. www.FormsWorkFlow.com THE INFORMATION BELOW IS NOT TO BE PUBLISHED (SEC. 17924, B&P) REQUIREMENTS FOR FILING THE WITHDRAWAL (Sec. 17923 B&P Code) A. Any person who is a general partner in a partnership that is or has been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 parthership 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. B. 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 on affidavit showing the publication of the statement shall be filed with the county clerk after the completion of the publication. C. 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 (a) above, these instructions, and if the publication requirement of (b) above is satisfied. INSTRUCTIONS FOR COMPLETING THE WITHDRAWAL (Sec. 17922 B&P Code) Type or print legibly and firmly in black ink. A. Insert the original File Number where indicated on form. B. 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 clerk’s form Additional Information may be used to list additional names. C. Insert the street address of the principal place of business. (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. D. Insert the date on which the fictitious business name statement relating to the withdrawing partner was filed. E. Insert the full name and residence address of each person withdrawing as a partner. (P.O. Box, postal drop box, mailing suite, or c/o addresses are not acceptable.) F. 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 or 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