Statement Form Of Withdrawal From Partnership Operating Under Fictitious Business Name
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2P.O. Box 751, Riverside, CA 92502-0751 -- (951) 486-7000
38686 El Cerrito Road, Palm Desert, CA 92211 -- (760) 863-8732
Assessor-County Clerk-Recorder
OFFICE OF THE COUNTY CLERK
WITHDRAWAL
STATEMENT OF
FROM PARTNERSHIP OPERATING
UNDER FICTITIOUS BUSINESS NAME
Page __1__ of _____
--USE BLACK INK ONLY--
MUST BE TYPED OR PRINTED
FILING FEE $24.00
County of Riverside
Receipt # _________________
The following person has withdrawn as a general partner
from the partnership operating under the fictitious
business name of:
FILE NO
. _____________________________
*
________________________________________________________________________________________________________________________________
Fictitious Business Name(s)
________________________________________________________________________________________________________________________________
Business Address, City, State and Zip Code AND COUNTY of Principal Place of Business in Riverside County (No P.O. or Mail Boxes)
**
________________________________________________________________________________________________________________________________
Full Name of Registrant - First, Middle and Last
________________________________________________________________________________________________________________________________
Residence Address
________________________________________________________________________________________________________________________________
City
State
Zip
________________________________________________________________________________________________________________________________
(If corporation or limited liability company, state of incorporation or organization)
*** This business is conducted by:
□ a General Partnership
□ a Limited Partnership
□ Limited Liability Partnership
□ Co-Partners
□ Joint venture
□ State or Local Registered Domestic Partnership
**** The fictitious business name(s) referred to above was filed in Riverside County on
________________________________________
***** I declare that the information in this statement is true and correct. (A registrant who declares as true, information
which he or she knows to be false is guilty of a crime.)
Signature
______________________________________________________________________________________________________________________
Typed or Printed Name
________________________________________________________________________________________________________
If Limited Liability Company/Corporation - Title
______________________________________________________________________________
This statement was filed with the County Clerk of Riverside County on date indicated by file stamp above
.
SEE REVERSE SIDE FOR INSTRUCTIONS
ACR 503 (Rev. 11/2014)
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