Form Gs 53-14 - General Partnership/limited Liability Partnership Statement Of Dissociation
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1KANSAS SECRETARY OF STATE
Contact Information
GS
General Partnership/Limited Liability Partnership
Kansas Secretary of State
Statement of Dissociation
Ron Thornburgh
53-14
Memorial Hall, 1st Floor
All information must be completed or this document will not be accepted for filing.
120 S.W. 10th Avenue
Topeka, KS 66612-1594
(785) 296-4564
Print
Reset
Please complete the form, print, sign and
mail to the Kansas Secretary of State with
1. Name of the partnership:
the filing fee. Selecting 'Print' will print
____________________________________________
the form and 'Reset' will clear the entire
form.
Name must match the name on record with the secretary of state
Do not write in this space
2. Partner dissociated from the partnership:
____________________________________________________
____________________________________________________
I/We declare the above-named partner to be dissociated from the general partnership.
I/We declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct.
Executed on the ________ of ___________ , _____________
.
Day
Month
Year
If filed by a dissociating partner, the dissociating partner must sign.
_________________________________________________
Signature
If filed by the partnership, two partners must sign.
_________________________________________________
Signature
______________________________________________________
Signature
Instructions
1. A certified copy of a statement of dissociation filed in another state may be filed instead of this form.
2. Submit this form with the $35 filing fee.
Notice: There is a $25 service fee for all returned checks.
Rev. 12/28/04 jls
Rev. 8/11/03
K.S.A. 56a-105
K.S.A. 56a-704
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