Form Dscb:15-8474/8665 - Certificate Of Dissociation As A Partner Page 2
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2DSCB:15-8474/8665–Instructions
Pennsylvania Department of State
Bureau of Corporations and Charitable Organizations
P.O. Box 8722
Harrisburg, PA 17105-8722
(717) 787-1057
Website:
partnership. This field is required.
General Information
Typewritten is preferred. If handwritten, the form must be
Post office boxes are not acceptable for any address. Under
legible and completed in black or blue-black ink in order to
15 Pa.C.S. § 135(c) (relating to addresses) an actual street or
permit reproduction. The nonrefundable filing fee for this
rural route box number must be used as an address, and the
form is $70.
Department of State is required to refuse to receive or file any
Checks should be made payable to the Department of State.
document that sets forth only a post office box address.
Checks must contain a commercially pre-printed name and
address.
3. Set forth the name of the person who has dissociated from
the partnership. This field is required.
This form and all accompanying documents, including any
necessary governmental approvals, shall be mailed to the
4. Check appropriate box for either general or limited
address stated above.
partnership. Check only one box. Mandatory statement. This
field is required.
Who should file this form?
When a person has dissociated or withdrawn as a general
Signature and Verification
partner from a general or limited partnership, that person may
A Certificate of Dissociation must be signed by the person
deliver to the Department of State a Certificate of
dissociated as a general partner. Signing a document delivered
Dissociation.
to the Department for filing is an affirmation under the
penalties provided in 18 Pa.C.S. § 4904 (relating to unsworn
Applicable Law
falsification to authorities) that the facts stated in the
For requirements for Certificate of Dissociation, see 15
document are true in all material respects.
Pa.C.S. § 8474 (general partnerships) and 15 Pa.C.S. § 8665
This field is required.
(limited partnerships). For events which cause dissociation,
see 15 Pa.C.S. § 8461 (general partnerships) and 15 Pa.C.S. §
8663 (limited partnerships). Statutes are available on the
Pennsylvania General Assembly website,
, by following the link for Statutes.
Form Instructions
Enter the name and mailing address to which any
correspondence regarding this filing should be sent.
This field must be completed for the Bureau to return the
filing. If the filing is to be returned by email, an email address
must be provided. An email will be sent to address provided,
containing a link and instructions on how a copy of the filed
document or correspondence may be downloaded. Any email
or mailing addresses provided on this form will become part
of the filed document and therefore public record.
1. Give the exact name of the general or limited partnership.
The name on this line must match exactly the association
name as shown in Department’s records, if applicable, at the
time the Certificate of Dissociation is submitted for filing.
This field is required.
2. Current address. The address provided must be the address
of the partnership’s principal place of business if the
partnership is a domestic general partnership or limited
liability partnership (a) or the partnership’s registered office
address (b) as on file with the Department of State at the time
the Certificate of Dissociation is submitted for filing, if the
partnership is a limited partnership or limited liability limited
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