Form LP 203 August 2012 Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 357 Springfield, IL 62756 217-524-8008 www.cyberdriveillinois.com Payment may be made by check payable to Secretary of State. If check is returned for any reason this filing will be void. Please do not send cash. Illinois Uniform Limited Partnership Act FILE # This space for use by Secretary of State. Statement of Termination of Certificate of Limited Partnership SUBMITINDUPLICATE Please type or print clearly. Filing Fee: $25 Approved: 1. Limited PartnershipName:________________________________________________________________ 2. Date of filing initial Certificate of Limited Partnership: __________________________________________ 3. Address to which the Secretary of State may mail a copy of any process against the Limited Partnership that may be served on him/her (P.O. Box only is unacceptable): ____________________________________________________________________________________ ____________________________________________________________________________________ The undersigned affirms, under penalties of perjury, that the facts stated herein are true, correct and complete. All General Partners are required to sign the Statement of Termination, except as provided in Section 204(3) or (4). 1. Dated: ___________________________________ Month, Day, Year 2. Dated: __________________________________ Month, Day, Year ________________________________________ Signature ________________________________________ Signature ________________________________________ Name and Title (type or print) ________________________________________ Name and Title (type or print) ________________________________________ General Partner Name if corporation or other entity ________________________________________ General Partner Name if corporation or other entity 3. Dated: ___________________________________ Month, Day, Year 4. Dated: __________________________________ Month, Day, Year ________________________________________ Signature ________________________________________ Signature ________________________________________ Name and Title (type or print) ________________________________________ Name and Title (type or print) ________________________________________ General Partner Name if corporation or other entity ________________________________________ General Partner Name if corporation or other entity Signatures must be in black ink on an original document. Carbon copy, photocopy or rubber stamp signatures may only be used on conformed copies. Printed by authority of the State of Illinois. July 2016 -- 1 -- CLP 4.12 American LegalNet, Inc. www.FormsWorkFlow.com