Form Gp-4 - General Partnership Dissolution Statement Page 2
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1
2FORM T-4
7/2010
Instructions: Assignment must be typewritten or printed in black ink, and must be legible. Signature must be in black ink. Submit
assignment together with the appropriate fee.
Assignment must be signed by the assignor (registrant) only. For corporations, assignment must be signed by an authorized officer of the
corporation. For general or limited partnerships, assignment must be signed by a general partner. For LLC, assignment must be signed by
a manager of a manager-managed company or by a member of a member-managed company. For LLP, assignment must be signed by a
partner.
Line 1.
State the full name of the assignor (the current owner of the registration). State the complete address (including city, state, and zip
code) of the assignor.
Line 2.
Check one box to indicate the status of the assignor. If you check “Other,” you must explain what type of entity the assignor is.
If the assignor is a corporation, partnership, or limited liability company, list the state or country in which it was incorporated, formed
or organized.
Line 3.
State the full name of the assignee (the one to whom the registration is being assigned). State the complete address (including city,
state, and zip code) of the assignee.
Line 4.
Check one box to indicate the status of the assignee. If you check “Other,” you must explain what type of entity the assignee is.
If the assignee is a corporation, partnership, or limited liability company, list the state or country in which it was incorporated, formed
or organized.
Line 5.
(a) State the trade name, trademark or service mark to be assigned. If the mark being assigned includes a design, state the
complete description of the mark and submit a sample of the design which is being assigned.
(b) State the Certificate No. of the trade name, trademark or service mark being assigned.
(c)
State the classification of the trademark or service mark being assigned.
Filing Fees: Filing fee ($10.00) is not refundable. Make checks payable to DEPARTMENT OF COMMERCE AND
CONSUMER AFFAIRS. Dishonored Check Fee $25.00.
For any questions call (808) 586-2727. Neighbor islands may call the following numbers followed by 6-2727 and the # sign:
Kauai 274-3141; Maui 984-2400; Hawaii 974-4000, Lanai & Molokai 1-800-468-4644 (toll free).
Fax: (808) 586-2733
Email Address:
breg@dcca.hawaii.gov
NOTICE: THIS MATERIAL CAN BE MADE AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS. PLEASE CALL THE DIVISION
SECRETARY, BUSINESS REGISTRATION DIVISION, DCCA, AT 586-2744, TO SUBMIT YOUR REQUEST.
ALL BUSINESS REGISTRATION FILINGS ARE OPEN TO PUBLIC INSPECTION. (SECTION 92F-11, HRS)
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