249 STATEMENT OF DENIAL To the SECRETARY OF STATE, STATE OF IDAHO (Instructions on back of application) Pursuant to Idaho Code § 53-3-304, the undersigned applies to the Secretary of State for statement of denial. 1. The name of the partnership is: 2. The date of filed statement of partnership of authority is: 3. As a partner listed in the statement of partnership authority I deny my authority or status as a partner. Signature: Typed name: Signature: Typed Name: Revision 01/2001 Date: Secretary of State use only g:\corp\forms\gpforms\pdenial.p65 4. Must be signed by at least 1 partner: American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS Optional: If the document is incorrect where can you be reached for questions? Complete and submit the application in duplicate. 1. Line 1 - Enter the name of the partnership as it reads on the record of the Secretary of State's Office. 2. Line 2 - Enter the date the statement of partnership authority was filed with the Secretary of State's Office. 3. Line 3 is a statement of a partner denying association with the partnership. Required by Idaho code. The statement of denial must be signed by at least 1 partner and the person signing the document must be identified by typing his/her name below the signature. 4. Enclose the appropriate fee: a. If the application is typed, the fee is $30.00. b. If the application is not typed or a non standard form is used, the fee is $50.00. c. If expedited service is requested, add $20.00 to the filing fee. d. If the fees are to be paid from the filing party’s pre-paid customer account, conspicuously indicate the customer account number in the cover letter or transmittal document. 5. Mail or deliver to: Office of the Secretary of Idaho Secretary of State State 700 West Street 450 N 4th Jefferson PO Box 83720 PO Box 83720 Boise ID 83720-0080 Boise ID 83720-0080 6. If you have questions or need help, call the Secretary of State’s Office at (208) 334-2301. American LegalNet, Inc. www.FormsWorkflow.com