Certificate of Withdrawal of Partner From Business Under A Fictitious or Assumed Name : Please fill out the following form. Please print your completed form if you would to have a copy for your records.




The following is hereby certified :


1. The undersigned (Enter the name of the person who signs this certificate) and whose address is (Enter the address of the undersigned) have withdrawn as (Enter either Fictitious or Assumed) partner(s) from the partnership doing business under the (Enter either Fictitious or Assumed) name of (Enter the name of business).


2. The partnership has its principal place of business located at (Enter the address of business).


3. The name (Enter either Fictitious or Assumed) certificate with respect to said business name was filed on (date) in the office of (Enter the applicable state office) State of )Enter the name of the state).


Date :


STATE OF :


COUNTY OF :


On _______________________ before me _________________________ personally appeared ___________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.


WITNESS my hand and official seal.


Signature :


Affiant : Known / Unknown :


ID Produced :


Seal :





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Certificate of Withdrawal of Partner From Business
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