8. If management vests with the members, name and address of each member: If management vests with managers, name and address of
each manager:
Name
Street address
City
State
Zip
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
(If additional space is necessary, please attach another page.)
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
By: __________________________________________________
Manager or Member
LLC Mailing Information
Where would you like the Secretary of State’s office to send official mail? If no address is given, the mail will be sent to the LLC’s
registered office.
Street address
City
State
Zip
The mail should be addressed to the following named individual: ___________________________________________________
Instructions
1. This application must include an original certificate of good standing or existence issued by the
jurisdiction of its organization and dated within 90 days of the filing of this application.
2. Submit this form with the $165 filing fee.
Notice: There is a $25 service fee for all returned checks.
K.S.A. 17-76,121
K.S.A. 17,76121
R
ev. 8/11/03 jb
Page 2 of 2
Rev. 12/28/04 jls