248 STATEMENT OF DISSOCIATION To the SECRETARY OF STATE, STATE OF IDAHO (Instruction on back of application) Pursuant to Idaho Code § 53-3-704, the undersigned applies to the Secretary of State for statement of dissociation. 1. The name of the partnership is: 2. The date of filed statement of partnership authority is: 3. The following partner(s) are hereby dissociated from the above mentioned partnership. Revision 1/2001 4. Signature of at least 1 partner: Date: Signature: Typed name: Signature: Typed Name: g:\corp\forms\gpforms\pdissociate.p65 Secretary of State use only 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 - Enter the names of the partner(s) being dissociated from the partnership 4. The statement of dissociation 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. 5. 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. 6. Mail or deliver to: Office of the Secretary of Idaho Secretary of State State 700 West Jefferson 450 N 4th Street PO Box 83720 PO Box 83720 Boise ID 83720-0080 Boise ID 83720-0080 7. If you have questions or need help, call the Secretary of State’s Office at (208) 334-2301. American LegalNet, Inc. www.FormsWorkflow.com