LP or LLLP Name: _____________________________________________________________
Entity Number: _______________________
The dissolution of above named company will become effective:
upon filing with the Division of Corporations and Commercial Code.
on the IXWXUH effective date of 00''<<<<________ ._____________
This Statement of Dissolution must be signed by all general partners listed in the certificate of limited
partnership or, if the certificate of a dissolved limited partnership lists no general partners, by the person
appointed pursuant to Subsection 48-2e-802(3) or (4)
to wind up the dissolved limited partnership's activities
and affairs.
Under penalties of perjury, I declare that this Statement of Dissolution 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: _____________
Additional filing requirements:
If the filer requests a copy of the Statement of Dissolution an additional exact copy of the filed document along
with a return-addressed envelope with adequate first-class postage must also be submitted.
Under GRAMA {63G-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 Dissolution
This form cannot be hand written.
Print
Clear Form
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
Division's Website:
11/16