· · · Filing Fee $23.00 If mailing this form: o Submit original, 2 copies o Self-addressed stamped envelope (Extra postage required) No BLANK or NOT TO EXCEED checks are accepted CATHY DARLING ALLEN ­ Shasta County Clerk 1643 Market Street Redding, CA 96001 PO Box 990880, Redding, CA 96099-0880 530-225-5730 CA Relay Service 711 or 800-735-2922 STATEMENT OF WITHDRAWL FROM PARTNERSHIP OPERATION UNDER FICTITIOUS BUSINESS NAME See reverse for instructions ­ The information you provide is public record The following person(s) has/have withdrawn as a general partner(s) from the partnership operating under: Fictitious Business Name(s) ______________________________________________________________________________________________________________ Phone: (Optional) ______________________________________________________________________________________________________________ Street Address of Principal Place of Business Mailing Address (if different) City _____________________________________________________________________________________________________________ State Zip County City State Zip County Full Name of General Partner Residence Address City State Zip Code Full Name of 2nd General Partner Residence Address City State Zip Code Full Name of 3rd General Partner Residence Address City State Zip Code Full Name of 4th General Partner Residence Address City State Zip Code Original File Number: ____________________________ This business is conducted by: (check one only) A Married Couple Co-Partners Joint Venture A Limited Liability Partnership A Trust A Limited Partnership A General Partnership Original File Date: ___________________________ A Limited Liability Company A Corporation An Unincorporated Association other than a Partnership State or Local Registered Domestic Partners NOTICE ­ In accordance with subdivision (a) of Section 17923 of the Business and 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 By signing below, I DECLARE THAT ALL INFORMATION IN THIS STATEMENT IS TRUE AND CORRECT. A registrant who executes this statement knowing that such statement is false in whole/in part shall be guilty of a misdemeanor punishable by a fine not to exceed one thousand dollars ($1,000). ____________________________________________________ Signature __________________________________________________ Type or Print Name and Title _____________________________________________________ If a Corporation or Limited Liability Company Name State of Incorporation American LegalNet, Inc. www.FormsWorkFlow.com THE BELOW INSTRUCTIONS ARE NOT TO BE PUBLISHED (Sec. 17924, B & P) INSTRUCTIONS FOR COMPLETION OF STATEMENT The information you provide is public record GENERAL PARTNERS MAY BE WITHDRAWN ONLY FROM FICTITIOUS BUSINESS NAME STATEMENTS FILED IN THE PREVIOUS 5 YEARS 1) Original file number and file date from the fictitious business name statement that contains the name(s) being abandoned. 2) Fictitious business name(s) from the original fictitious business name statement. Only business names shown on the original statement may be listed on this withdrawal. 3) Street address of the principal place of business as shown on the original statement. Post Office box and private mail facilities are not acceptable. Enter the county where the business was located in this state. 4) Full name and residence address of the withdrawing General Partner(s). Enter the. If the withdrawing general partner(s) is a Corporation, Limited Liability Company; name of the entity with legal address and state of incorporation. 5) Select the box that best describes how the business was conducted. This must be the same as the original statement. Signatures are required as follows: Individual ­ the individual; Husband and wife ­ withdrawing partner; Partnerships or other associations of persons ­ withdrawing general partner; Joint venture ­ withdrawing party to venture; Trust ­ a trustee; Corporations and Limited Liability Companies ­ an officer or manager. CALIFORNIA BUSINESS & PROFESSIONS CODE SECTION 17926. (a) As used in this section, "statement" means a fictitious business name statement, a statement of abandonment of use of fictitious business name, or a statement of withdrawal from partnership operating under fictitious business name. SECTION 17923. (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. (b) The statement shall include: (1) The fictitious business name of the partnership. (2) The date on which the fictitious business name statement for the partnership was filed, the file number, and the county where filed. (3) The street address of its principal place of business in this state or, if it has no place of business in this state, the street address of its principal place of business outside this state, if any. (4) The full names and residence addresses of the person or persons withdrawing as partners. (c) 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. (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 meeting the requirements of this section. SECTION 17917(a) ­ Within 30 days after a fictitious business name statement has been filed pursuant to this chapter, the registrant shall cause a statement