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Set forth the name of the person who has dissociated from the partnership. This field is required. 4.Complete part (a) OR (b) – not both: (a) The partnership is a domestic general partnership that has not elected limited liability status and the address,. Complete the Statement of Dissociation (Form GP-3) as follows: Item 1. Enter the name of the partnership as filed with the Secretary of State of California. 4355 Statement of dissolution. Statement Of Dissociation Form. This is a California form and can be use in General Partnerships Secretary Of State. (14) "Surviving partnership" means a domestic or foreign partnership into which one or more domestic or foreign partnerships are merged. Choosing a Partnership Name.