P.O. Box 751, Riverside, CA 92502-0751 -- (951) 486-7000 82-675 Hwy. 111, Rm. 113, Indio, CA 92201 -- (760) 863-8732 Assessor-County Clerk-Recorder OFFICE OF THE COUNTY CLERK STATEMENT OF WITHDRAWAL FROM PARTNERSHIP OPERATING UNDER FICTITIOUS BUSINESS NAME --USE BLACK INK ONLY-MUST BE TYPED OR PRINTED County of Riverside Page __1__ of _____ FILING FEE $27.00 Receipt # _________________ The following person has withdrawn as a general partner from the partnership operating under the fictitious business name of: FILE NO. _____________________________ * ________________________________________________________________________________________________________________________________ Fictitious Business Name(s) ________________________________________________________________________________________________________________________________ Business Address, City, State and Zip Code AND COUNTY of Principal Place of Business in Riverside County (No P.O. or Mail Boxes) ** ________________________________________________________________________________________________________________________________ Full Name of Registrant - First, Middle and Last ________________________________________________________________________________________________________________________________ Residence Address ________________________________________________________________________________________________________________________________ City State Zip ________________________________________________________________________________________________________________________________ (If corporation or limited liability company, state of incorporation or organization) *** This business is conducted by: Ƒ a General Partnership Ƒ Joint venture Ƒ a Limited Partnership Ƒ State or Local Registered Domestic Partnership Ƒ Limited Liability Partnership Ƒ Co-Partners Ƒ Other (Specify) ______________ **** The fictitious business name(s) referred to above was filed in Riverside County on ________________________________________ ***** I declare that the 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.) Signature ______________________________________________________________________________________________________________________ Typed or Printed Name ________________________________________________________________________________________________________ If Limited Liability Company/Corporation - Title ______________________________________________________________________________ This statement was filed with the County Clerk of Riverside County on date indicated by file stamp above. SEE REVERSE SIDE FOR INSTRUCTIONS ACR 503P-AS4CL0 (Rev. 07/2010) American LegalNet, Inc. www.FormsWorkFlow.com THE INSTRUCTIONS BELOW ARE NOT TO BE PUBLISHED (Sec. 17923 and 17924, Business & Professions Code) INSTRUCTIONS FOR COMPLETION OF STATEMENT Section 17923 Business & Professions Code (*) The fictitious business name of the partnership. (**) The full name and residence of the person withdrawing as a partner. (***) Mark the box that best describes the nature of the fictitious business name. (****) Insert the date the fictitious business name statement was filed in Riverside County. (*****) Statement must be signed by the partner who is withdrawing from the partnership. .................................................................................................................................................................. NOTICE Section 17923 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 files its fictitious business name statement. (c) 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 (d) The withdrawal of a general partner does not cause a fictitious name statement to expire if the withdrawing partner files a statement of withdrawal in accordance with subdivision (a) and (b) and the requirement of subdivision (c) is satisfied. If the file number begins with an "R", your document should be filed in the Riverside office. If the number begins with an "I", your document should be filed in Indio. (See front of form for addresses) ACR 503P-AS4CL0 (Rev. 07/2010) American LegalNet, Inc. www.FormsWorkFlow.com