"Statement of Dissociation" - Colorado

Statement of Dissociation is a legal document that was released by the Colorado Secretary of State - a government authority operating within Colorado.

Form Details:

  • Released on August 28, 2017;
  • The latest edition currently provided by the Colorado Secretary of State;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Colorado Secretary of State.

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Download "Statement of Dissociation" - Colorado

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Document processing fee
If document is filed on paper
$150.00
If document is filed electronically
Not available
For more information or to print copies
of filed documents, visit www.sos.state.co.us.
Must be typewritten or machine printed.
ABOVE SPACE FOR OFFICE USE ONLY
Statement of Dissociation
filed pursuant to §7-90-301, et seq. and
§7-64-704
of the Colorado Revised Statutes (C.R.S)
1. The true name is
.
2. If applicable, for the entity, its ID number and entity name are
Entity name
(if different from true name)
.
ID number
_________________________
(Colorado Secretary of State ID number)
3. The name of partner is
(if an individual)
____________________ ______________ ______________ _____.
(Last)
(First)
(Middle)
(Suffix)
OR
(if a business organization)
.
4. The partner is dissociated from the partnership.
5.
(Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has significant legal
consequences. Read instructions before entering a date.)
(If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required format.)
The delayed effective date and, if applicable, time of this document is/are ______________________.
(mm/dd/yyyy hour:minute am/pm)
Notice:
Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that such document is such
individual's act and deed, or that such individual in good faith believes such document is the act and deed of the person
on whose behalf such individual is causing such document to be delivered for filing, taken in conformity with the
requirements of part 3 of article 90 of title 7, C.R.S. and, if applicable, the constituent documents and the organic
statutes, and that such individual in good faith believes the facts stated in such document are true and such document
complies with the requirements of that Part, the constituent documents, and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the Secretary of State,
whether or not such individual is identified in this document as one who has caused it to be delivered.
6. The true name and mailing address of the
individual causing the document
to be delivered for filing are
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
______________________________________________________
(Street name and number or Post Office Box information)
______________________________________________________
DISSO_64PART
Page 1 of 2
Rev. 8/28/2017
Document processing fee
If document is filed on paper
$150.00
If document is filed electronically
Not available
For more information or to print copies
of filed documents, visit www.sos.state.co.us.
Must be typewritten or machine printed.
ABOVE SPACE FOR OFFICE USE ONLY
Statement of Dissociation
filed pursuant to §7-90-301, et seq. and
§7-64-704
of the Colorado Revised Statutes (C.R.S)
1. The true name is
.
2. If applicable, for the entity, its ID number and entity name are
Entity name
(if different from true name)
.
ID number
_________________________
(Colorado Secretary of State ID number)
3. The name of partner is
(if an individual)
____________________ ______________ ______________ _____.
(Last)
(First)
(Middle)
(Suffix)
OR
(if a business organization)
.
4. The partner is dissociated from the partnership.
5.
(Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has significant legal
consequences. Read instructions before entering a date.)
(If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required format.)
The delayed effective date and, if applicable, time of this document is/are ______________________.
(mm/dd/yyyy hour:minute am/pm)
Notice:
Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that such document is such
individual's act and deed, or that such individual in good faith believes such document is the act and deed of the person
on whose behalf such individual is causing such document to be delivered for filing, taken in conformity with the
requirements of part 3 of article 90 of title 7, C.R.S. and, if applicable, the constituent documents and the organic
statutes, and that such individual in good faith believes the facts stated in such document are true and such document
complies with the requirements of that Part, the constituent documents, and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the Secretary of State,
whether or not such individual is identified in this document as one who has caused it to be delivered.
6. The true name and mailing address of the
individual causing the document
to be delivered for filing are
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
______________________________________________________
(Street name and number or Post Office Box information)
______________________________________________________
DISSO_64PART
Page 1 of 2
Rev. 8/28/2017
__________________________ ____
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
(If the following statement applies, adopt the statement by marking the box and include an attachment.)
This document contains the true name and mailing address of one or more additional individuals causing the
document to be delivered for filing.
Disclaimer:
This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, and are
furnished without representation or warranty. While this form/cover sheet is believed to satisfy minimum legal
requirements as of its revision date, compliance with applicable law, as the same may be amended from time to time,
remains the responsibility of the user of this form/cover sheet. Questions should be addressed to the user’s legal, business
or tax advisor(s).
DISSO_64PART
Page 2 of 2
Rev. 8/28/2017
Mail form with correct payment to:
Colorado Secretary of State
1700 Broadway Ste 200
Denver, CO 80290
Make checks payable to: Colorado Secretary of State
Include a separate check for each form submitted for filing.
If a document is rejected, this will allow us to return the check at
the time of rejection (if applicable). The document can be
corrected and resubmitted with the returned check.
Checks must be written for the exact amount
or the document may be rejected and returned.
Do not include this page with your filing.
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