Form Kc 53-02 - Kansas Limited Liability Company Certificate Of Cancellation
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1KANSAS SECRETARY OF STATE
Contact Information
KC
Kansas Limited Liability Company
Kansas Secretary of State
Certificate of Cancellation
Ron Thornburgh
53-02
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 company:
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. Reason for cancellation:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
I 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
Authorized person
Instructions
1. Submit this form with the $35 filing fee.
2. If this certificate of cancellation is filed after the limited liability company’s fiscal year end, the annual
report and franchise fee for the last fiscal year must be filed. If the LLC has forfeited, it must reinstate
before cancellation.
Notice: There is a $25 service fee for all returned checks.
Rev . 4/05/04 amc
. 12/08/04 jls
Rev
K.S.A. 17-7675
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