COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION UPA-94 (08/06) STATEMENT OF DENIAL FOR A PARTNERSHIP This statement may be filed by and must be executed by a partner or other person named in a filed statement of partnership authority or named in a list maintained by an agent pursuant to § 50-73.93 B of the Code of Virginia. The undersigned presents this statement of denial pursuant to § 50-73.94 of the Code of Virginia. 1a. The name of the partnership is _____________________________________________________________________. 1b. The partnership is formed under the laws of __________________________________. (state or country) 2. (CHECK ONE) The partner or other person is named as a partner in a statement of partnership authority filed on ________________________, file number ___________________, (month, day, year) with the State Corporation Commission pursuant to § 50-73.94 of the Code of Virginia. OR The partner or other person is named in a list maintained by an agent pursuant to § 50-73.93 B of the Code of Virginia. 3. The following fact(s) is (are) denied: (Note: May include denial of a person’s authority or status as a partner.) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 4. Signature of partner or other person: The individual executing this document personally declares under penalty of perjury that the contents are accurate. __________________________ _________________________ (signature) ______________ (printed name) _________________________ (partnership’s SCC ID no.) (date) ______________________________ (telephone number (optional)) SEE INSTRUCTIONS ON THE REVERSE American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS Section 50-73.83 of the Code of Virginia requires that this statement 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. A statement of denial for a partnership may be filed if the partnership has filed with the State Corporation Commission a statement of partnership authority that has not been canceled. Among the denial of other facts, this statement of denial may include the denial of a person’s authority or status as a partner. A statement of denial is a limitation on authority as provided in subsections D and E of § 50-73.93 of the Code of Virginia. The person who files this statement must promptly send a copy of the statement to every nonfiling partner and to any other person named as a partner in the statement. See § 5073.83 of the Code of Virginia. This statement must be signed by at least one partner or other person. Each person signing this statement must set forth his printed name next to his 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 statement to the Clerk of the State Corporation Commission, P.O. Box 1197, Richmond, Virginia 23218-1197, (Street address: 1300 E. 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, 1-866722-2551. American LegalNet, Inc. www.FormsWorkflow.com