COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION UPA-83D-CANC (01/06) CANCELLATION OF PARTNERSHIP STATEMENT The undersigned present this cancellation for filing pursuant to § 50-73.83 D of the Code of Virginia. (Note: A cancellation of a partnership statement cannot be filed with the State Corporation Commission unless the partnership statement being canceled was previously filed and is of record with the Commission.) 1a. The name of the partnership is ____________________________________________________________________________. 1b. The partnership is formed under the laws of _________________________________________. (state or country) 2. The partnership’s SCC ID number is _______________________________________________. 3. This cancellation cancels the following statement which was filed on ______________________. (month, day, year) (MARK ONE): Statement of Partnership Authority Statement of Denial Statement of Dissociation Statement of Dissolution Statement of Merger 4. Text/substance of cancellation: 5. Signatures of partners (must be executed by at least two): The individuals executing this document personally declare under penalty of perjury that the contents are accurate. _________________________________ ______________________________ _________ (signature) (printed name) (date) _________________________________ ______________________________ _________ (signature) (printed name) (date) Telephone number (optional): ________________________________________ INSTRUCTIONS ON THE REVERSE American LegalNet, Inc. www.USCourtForms.com INSTRUCTIONS Section 50-73.83 of the Code of Virginia requires that this cancellation be in the English language, typewritten or printed in black, legible and reproducible. The document must be presented on uniformly white, opaque paper, free of visible watermarks and background logos. You can download this form from our website at www.scc.virginia.gov/division/clk/fee_bus.htm. Any person authorized by the Virginia Uniform Partnership Act, Chapter 2.2 of Title 50 of the Code of Virginia, to file a statement listed on the front of this form in paragraph 3, may cancel the filed statement by filing this cancellation. The person who files this cancellation must promptly send a copy of the cancellation to every nonfiling partner and to any other person named as a partner in the cancellation. See § 50-73.83 of the Code of Virginia. This cancellation must be signed by at least two partners. Each person signing this cancellation must set forth his or her printed name next to or beneath his or her signature. A person signing on behalf of a partner that is a business entity should set forth the business entity’s name, his or her printed name, and the capacity in which he or she is signing on behalf of the business entity. See § 50-73.83 C of the Code of Virginia. Submit the original, signed cancellation to the Clerk of the State Corporation Commission, P.O. Box 1197, Richmond, Virginia 23218-1197, (Street address: 1300 East Main Street, Tyler Building, 1st Floor, Richmond, Virginia 23219), along with a check for the filing fee in the amount of $25.00, payable to the State Corporation Commission. PLEASE DO NOT SEND CASH. If you have any questions, please call (804) 371-9733 or toll-free in Virginia, 1-866-722-2551. American LegalNet, Inc. www.USCourtForms.com