For Office Use Only GENERAL PARTNERSHIP (Amendment/Cancellation of Partnership Statement) Corporate Filings 312 Rosa L. Parks Ave. 6th Floor, William R. Snodgrass Tower Nashville, TN 37243 1. The name of the general partnership (as recorded with the Secretary of State) is: 2. This document is (check only one): an amendment a cancellation 3. The document amends or cancels the (check and complete only one item): Statement of Partnership Authority filed on __________ Statement of Denial filed on __________ Statement of Dissociation filed on __________ Statement of Dissolution filed on __________ Statement of Merger filed on __________ 4. If an amendment, state the text/substance of the amendment: The execution of this statement constitutes an affirmation under the penalties of perjury that the undersigned has/have the authority to file this statement and that the contents of the statement are accurate. Signed and dated this _______ day of ____________________, _______ _________________________________ Signature _________________________________ Signature ________________________________ Printed Name ________________________________ Printed Name Note: A document filed by a partnership must be executed by at least two partners. Other documents must be executed by a partner or other person authorized by the Revised Uniform Partnership Act. SS-4519 Filing Fee: $20 RDA pending American LegalNet, Inc. www.FormsWorkFlow.com