1. Partnership name:
2. Check one: ❏ Partnership or ❏ Limited Liability Partnership
3. Federal Employer Identification Number (FEIN):
4. The above-named partnership has dissolved and is winding up its business.
5. If applicable, this Statement of Dissolution cancels any active Statement of Partnership Authority filed in
accordance with Section 303(d)and 303(e) filed:
The undersigned declares, under the penalty of perjury, under the laws of the State of Illinois, that the foregoing
is true, correct and complete.
Executed on the of , by a partner.
Printed by authority of the State of Illinois. November 2020 - 1 - UPA 11.5
(Name must be stated exactly as on record with the Secretary of State.)
Day Month Year
Signature Number, Street Address
Name and Title (type or print) City, State, ZIP
Secretary of State
Department of Business Services
Limited Liability Division
501 S. Second St., Rm. 357
Springfield, IL 62756
Uniform Partnership Act
Statement of Dissolution
Payment may be made by check
pay able to Secretary of State. If
check is returned for any reason
this filing will be void.
SUBMIT IN DUPLICATE
Type or print clearly.
Filing Fee: $100
This space for use by Secretary of State.