Statement Of Dissociation Form - 2012 printable pdf download

Statement Of Dissociation Form - 2012

STATEMENT OF DISSOCIATION

Secretary of State Office

500 E Capitol Ave

DOMESTIC LIMITED LIABILITY COMPANY

Pierre, SD 57501

Clear Form

(605)773-4845

Please Type or Print Clearly in Ink

Original

Photocopy

Please submit one

and one

HELP

FILING FEE: $10

SECRETARY OF STATE

payable to

Telephone # ____________________

FAX #

_______________________

The undersigned hereby files this statement of dissociation pursuant to SDCL 47-34A-605.

1. The name of the company is ______________________________________________________________________

______________________________________________________________________________________________

Note: This must be the exact limited liability company name.

2. The name of the member dissociated from the company is _______________________________________________

3. A copy of this statement has been delivered to the limited liability company

Dated ____________________________

______________________________________________

(Signature)

______________________________________________

(Printed Name)

______________________________________________

(Title)

domesticllcstatemenofdissociation April 2012

Statement Of Dissociation Form - 2012