RECORDING/FILING REQUESTED BY AND MAIL TO: NAME ______________________________________ STREET ______________________________________ CITY & STATE ______________________________________ FILING FEE $26.00 Current File No. ______________________ STATEMENT OF WITHDRAWAL FROM PARTNERSHIP OPERATING UNDER FICTITIOUS BUSINESS NAME The following person(s) has/have withdrawn as a general partner(s) from the partnership operating under the fictitious business name of___________________________________ located at (street address of principal place of business) ___________________________ ________________________________________________________________________. The fictitious business name statement for the partnership was filed on________________ in the County of ___________________________________________________________. The full name and residence of the person(s) withdrawing as a partner(s): (Please print or type) NAME ADDRESS ______________________________ _________________________________ _________________________________ ______________________________ _________________________________ _________________________________ ______________________________ _________________________________ _________________________________ ______________________________ _________________________________ _________________________________ 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.) SIGNED: ____________________________ _________________________________ ____________________________ _________________________________ This statement was filed with the County Clerk of Los Angeles County on the date indicated by file stamp above. SEE REVERSE SIDE FOR INSTRUCTIONS R1335 9/2010 American LegalNet, Inc. www.FormsWorkFlow.com THE BELOW INSTRUCTIONS ARE NOT TO BE PUBLISHED (SECTION 17924 B & P) INSTRUCTIONS FOR COMPLETION OF STATEMENT SECTION 17923 BUSINESS & PROFESSIONS CODE SECTION 17924 BUSINESS & PROFESSIONS CODE “(c) Unless a notice of dissolution of the partnership has been published pursuant to Section 15035.5 of the Corporations 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 completion of the publication.” NOTICE TO PERSON(S) “(d) 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 requirements if subdivision (c) is satisfied.” REGISTRAR-RECORDER/COUNTY CLERK BUSINESS FILING AND REGISTRATION SECTION P.O. BOX 1208 NORWALK, CA 90651-1208 PHONE: (562) 462-2177 The statement of withdrawal from Partnership Operating under Fictitious Business Name must be published in a newspaper once a week for four successive weeks and an affidavit of publication filed with the county clerk within 30 days after publication has been accomplished. The statement should be published in a newspaper of general circulation in the county where the principal place of business is located. The statement should be published in such county in a newspaper that circulates in the area where the e business is conducted. (Business & Professions Code Section 17917) 1. 2. Any person who executes, files or publishes any fictitious business name statement, knowing that such statement is false, in whole or in part, is guilty of a misdemeanor and upon conviction thereof shall be fined not to exceed five hundred dollars ($500.00). (Business & Professions Code Section 17930) R1335 9/2010 American LegalNet, Inc. www.FormsWorkFlow.com