Iowa Limited Partnership Registered Agent Resignation Form

In the case of a registered agent for a limited partnership that is registered in the State of Iowa wanting to resign and become relieved of his/her duties, the following form has to be completed and submitted.

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Read the instruct ions on  the r everse bef ore c omp letin g. 
 
A ll i tem s m ust b e c om plete d before th e statem ent of r es ign ation  wi ll b e c onside re d.  	
 
Statement	
 	
 
 
Name of B us ine ss E ntity :  ___ __ _____ ___ _____ ___ ____ _______ ___ _____ ___ ____ _______ ___ _____ ___ ____  
 
P rinc ipa l O ffice A ddres s: _ ____ _____ ___ _____ ___ ____ _______ ___ _____ ___ ____ _______ ___ _____ ___ ____ _ 
 
Regi stered O ffice A ddres s:  __ __ _____ ___ _____ ___ ____ _______ ___ _____ ___ ____ __ _____ ___ _____ ___ ____  
 	
 
TO THE  AB O VE N AM ED BU SINESS ENTIT Y. Plea se  be  ad vis ed  that noti ce  is  here by g iv en t o s aid  bus in ess e ntity  th at  I, 
_____ _______ _______ __________ _______ __, regi ste re d a gent  appe aring	
 o n th e r eco rd s o f  th e s e cre ta ry  o f s ta te  fo r t he 
bus ines s e ntity , do  h ereby  resign a s t he re gis te red a gent effective  _ ____ _______ __________.  The  re gis te red  off ic e  o f  th e 
bus ines s e ntity         is          is  n ot d is c o ntin ued a t th e s am e ti m e. 	
 
 
Signat ure  of Reg is te red Ag ent: ____ _______ _______ __________ _______ _______ _________  
 
Dat e:  _____ ____ _______ ________ ___ 
 
 
Cer tificate  o f  M ail ing	
 	
 
 
I,  _ ______ _______ _______ _______ _____,  regis te re d a gent  for _ _____ ____ _______ _________ _______ _______ ______ _ _,  
appear in g  on t he re co rd s o f th e s ecre tary o f sta te , here by c erti fie s t ha t  on  _ _____ _______ __ ___ ___ __ I  d id  s e nd  a  c opy  of th is  
Sta tement  of  Res ig na tio n  o f Regi ste re d Ag ent  by c erti fied  mail t o t he b usin e ss  e ntity           at  th e a bov e p rin cip al p la ce  o f bu sin e ss   
and            to  t he  a bo ve  re gis te red o ffic e , i f th e o ff ic e  w as n ot d is c ont in ued.  
 
Signat ure  of Reg is	
te red Ag ent: ____ _______ _______ __________ _______ _______ ________  
 
Dat e:  _____ ____ _______ ________ ___ 	
 
 
 
 
 
 
 
 
 	
 
 	
MAT T SC HUL TZ	 	
Se cret ary of  St ate  	
State  of Iow a	 	
ST ATEMENT  OF 
RESIG NATI ON O F 
REGIS TERE D AG ENT  	
 
635_0987	 	Rev.  12/ 11

INSTRUCTIONS 	
Read the in struct ions bef ore c omp letin g. 
A ll item s mu st be com ple ted	
be fore the  applic ati on  wi ll b e c onside red . 
P lea se print  or t yp e	
the  in for mati on  req uir ed  un les s a  sign ature  is  s pe cif ied . 
If  y o u a re  un cert ain ab out the  ac curac y of  an y of  the  req uir ed  inf orm ation c ontac t  the  S ec reta ry  of  State ’s  O	
c e
at  (51 5)  281-52 04 f or as sis tan ce.  
E ac h item  numbe r be lo w  c orr espo nds t o t he s am e num ber as  they a pp ear on  the S tatem ent	
orCer tif ica te  of M ail ing .	
Statem ent	
1.  Ins ert t he com plete  le ga l na me o f th e bu sine ss  en tit y . 
2.  In sert  th e a d dre ss o f t h e b usin ess  e ntit y ’s  pr in cip al p la ce  of b usin es s.
3.  Ins ert t he ad dres s of  the r eg is tere d offic e.  
4.  Ins ert  yo ur nam e. 
5.  State  the  da te o n w hic h t he res ig na tio n s hall  be com e effec tive.  
6.   P la ce  a n  “ X ” i n  th e a p propriate box to indicate whether the registered office is also being di\
scontinued. 
7.  Sign  the s tat em ent. 
8.  Ins ert t he da te th e s tat em en t w as sig ne d. 	
Certific ate of Mai ling	
1.  Ins ert  yo ur nam e. 
2.  Ins ert t he com plete  le ga l na me o f th e b usine ss en tit y . 
3 .Ins ert t he da te th e s tat em en t w as m ailed  to  the  bus ine ss en tity . 
 
5. Place an “X” in the box to indicate that the statement was sent\
 to the registered offices if the registered office is not being
    discontinued.   
  
 
6.  Sign  the c erti fic ati on . 
7.  Ins ert t he da te th e c erti fic ati on  w as  sig ne d. 
NO TE S: 
1.  The re i s n o f ili ng  fee . 
2.  The  inf orm ation  y ou  prov ide  wi ll  be  ope n to pu blic  in spe ction  un der Io wa C ode cha pte r 2 2.1 1. 
S EC RE TA RY  OF S TA TE  
B us in es s S ervic es  Div is io n  
Lu cas  Buildi ng , 1s t Fl oor  
Des  Moine s, I A 50 319  
P ho ne: (5 15)	
 281 -5 20 4 
              F AX : ( 51 5) 242 -5 95 3 
    W ebs ite:  sos.iowa.gov
4. Place an “X” in the box to indicate that the statement was sent\
 to the business entity’s principal office.