Form Ca 53-02 - Foreign Limited Liability Company Cancellation Of Authority To Do Business In Kansas

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KANSAS SECRETARY OF STATE
CA
Foreign Limited Liability Company
Cancellation of Authority to do
53-02
Business in Kansas
Kansas Office of the Secretary of State
CONTACT:
Memorial Hall, 1st Floor
(785) 296-4564
120 S.W. 10th Avenue
kssos@sos.ks.gov
Topeka, KS 66612-1594
Above space is for office use only.
All information must be completed or this document will not be accepted for filing.
i
INSTRUCTIONS:
Please read instructions before completing.
1. Business entity ID
number:
This is not the Federal Employer
_______________________________________
ID Number (FEIN)
2. Name of limited
liability company:
Name must match the name on
________________________________________________________________________________________
record with the Secretary of State
3. Service of process
may be forwarded to the
________________________________________________________________________________________
limited liability company
at the following address:
Name
Street Address
Address must be a street address.
______________________________________________________________________________________
A P.O. box is unacceptable
City
State
Zip
4. The above-named foreign limited liability company registered to do business in the state of Kansas pursuant to
Kansas law, hereby cancels its registration.
5. I/We declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct
and that I/we have remitted the required fee.
________________________________________________________ _______________________________________________________
Signature of member
Date (month, day, year)
Signature of member
Date (month, day, year)
________________________________________________________ ________________________________________________________
Signature of member
Date (month, day, year)
Signature of member
Date (month, day, year)
________________________________________________________ ________________________________________________________
Signature of member
Date (month, day, year)
Signature of member
Date (month, day, year)
Save time and money by filing your cancellation online at
i
Instructions:
1. If this form is submitted after the close of the entity’s tax year, an annual report and fee must be submitted along with
or prior to cancellation. If the entity has forfeited, it must reinstate before cancellation.
2. Submit this form with the $35 filing fee.
STAY UP-TO-DATE ON YOUR ORGANIZATION’S STATUS, ANNUAL REPORT DUE DATE AND CONTACT ADDRESSES BY GOING TO
UNDER QUICK LINKS, SELECT SEARCH BUSINESS ENTITY INFORMATION.
There is a $25 service fee for all checks returned by your financial institution.
NOTICE:
All information must be completed or this document will not be accepted for filing.
Page 1 of 1
Rev. 12/27/10 jdr
K.S.A . 17-76,125

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