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FORM UPA-805                                                   Illinois  
                                                                                                                FILE #:
October 2020                                            Uniform Partnership Act                                 This space for use by Secretary of State.
                                                   Statement of Dissolution
Secretary of State 
Department of Business Services 
Limited Liability Division                              SUBMIT  IN DUPLICATE 
501 S. Second St., Rm. 357                              Type or print clearly. 
Springfield, IL  62756 
217-524-8008
www.ilsos.gov
                                                  Filing Fee:    $100 
Payment may be made by check                      Approved:
pay  able to Secretary of State. If 
check is returned for any reason 
this filing will be void.

1. Partnership name:
                                                        (Name must be stated exactly as on record with the Secretary of State.)

2. Check one:   ❏ Partnership or     Limited❏     Liability Partnership

3. Federal Employer Identification Number (FEIN):

4. The above-named partnership has dissolved and is winding up its business.

5. If applicable, this Statement of Dissolution cancels any active Statement of Partnership Authority filed in
   accordance with Section 303(d)and 303(e) filed:
                                                                               Month/Day/Year
The undersigned declares, under the penalty of perjury, under the laws of the State of Illinois, that the foregoing 
is true, correct and complete. 

Executed on the                     of                  ,             by a partner. 
                           Day                    Month        Year

                           Signature                                                Number, Street Address

                   Name and Title (type or print)                                   City, State, ZIP

                                     Printed by authority of the State of Illinois. November 2020 - 1 - UPA 11.5