LP or LLLP Name: _____________________________________________________________
Entity Number: _______________________
This Statement of Withdrawal is filed to withdraw the ________________________________ filed on
Type of Record Filed
____________________________ with an effective date of _________________________________.
Date Filed with Division Effective Date of Record
This Statement of Withdrawal is signed by:
Each person that signed the record being withdrawn
Fewer than all the persons that signed the record being withdrawn, but the record is withdrawn in
accordance with the agreement of all the persons that signed the record.
Under penalties of perjury, I declare that this Statement of Withdrawal has been examined by me and is, to the
best of my knowledge and belief, true, correct and complete.
By: ________________________________________ Title: ______________________ Date: _____________
By: ________________________________________ Title: ______________________ Date: _____________
By: ________________________________________ Title: ______________________ Date: _____________
Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you
may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity.
State of Utah
Department of Commerce
Division of Corporations & Commercial Code
Statement of Withdrawal
This form cannot be hand written.
Sign here after the form is printed
Sign here after the form is printed
Sign here after the form is printed
Mailing/Faxing Information:
www.corporations.utah.gov/contactus.html
www.corporations.utah.gov
