Form Sds - Statement Of Dissociation (Domestic Or Foreign Partnership)
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1
2C
K
OMMONWEALTH OF
ENTUCKY
A
L
G
, S
S
LISON
UNDERGAN
RIMES
ECRETARY OF
TATE
_________________________________________________________________________________________________________________________
Division of Business Filings
Statement of Dissociation
SDS
Business Filings
PO Box 718
(Domestic or Foreign Partnership)
Frankfort, KY 40602
(502) 564-3490
__________________________________________________________________________________________
Pursuant to KRS 14A and KRS 362.1, the undersigned applies to qualify and for that purpose submits the following
statements:
1. Name of the partnership___________________________________________________________________________
(Name must be identical to the name of record with the Secretary of State)
2. List the partner/partners that is/are dissociated from the partnership.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. This application will be effective upon filing, unless a delayed effective date and/or time is provided. The effective date
or the delayed effective date cannot be prior to the date the application is filed. The date and/or time is______________.
(Delayed effective date
and/or time)
I/We declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct.
_________________________________________________________________________________________________
Signature of partner or authorized person
Type or Print Name
Date
(01/12)
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