Form Lc 50 - Limited Liability Company Annual Report
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1
2KANSAS SECRETARY OF STATE
LC
Limited Liability Company
50
Annual Report
Kansas Secretary of State, Chris Biggs
CONTACT:
Memorial Hall, 1st Floor
(785) 296-4564
120 S.W. 10th Avenue
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.
INSTRUCTIONS:
i
Please read instructions sheet before completing.
1. Business entity ID
number:
This is not the Federal Employer
_______________________________________
ID Number (FEIN)
2. Limited Liability
Company name:
Name must match the name on
record with the Secretary of State
________________________________________________________________________________________
3. Mailing address:
________________________________________________________________________________________
This address will be used to send
Attention Name
Address
official mail from the Secretary
of State’s office
_______________________________________________________________________________________
City
State
Zip
Country
Do not leave blank
Check this box if this is a new address. Our records will be updated ONLY if this box is checked.
4. Tax closing date:
______________________________
Month
Year
5. State of organization:
_______________________________________
6. List the names and
_______________________________________________________________________________________
1)
addresses of members
who own 5% or more of
Name
capital (Kansas LLCs
_______________________________________________________________________________________ _
only):
If additional space is needed
Address
City
State
Zip
Country
please provide an attachment
_______________________________________________________________________________________
2)
Name
________________________________________________________________________________________ _
Address
City
State
Zip
Country
______________________________________________________________________________________
3)
Name
________________________________________________________________________________________ _
Address
City
State
Zip
Country
7. Federal Employer ID
_______________________________________
Number (FEIN):
Page 1 of 2
K.S.A . 17-76,139
Rev. 6/01/10 nr
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