Form Ine 53-51 - Certificate Of Interest Exchange - Secretary Of State
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1
2INE
KANSAS SECRETARY OF STATE
Certificate of Interest
Exchange
53-51
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.
i
INSTRUCTIONS:
All information must be completed or this document will not be accepted for filing.
Please read instructions before completing.
Acquired Entity (giving up ownership):
1. Business entity ID
number:
This is not the Federal Employer
ID Number (FEIN)
_______________________________________
2. Business entity name:
_____________________________________________________________________________________
3. Type of entity:
___ For-Profit Corporation
___ General Partnership
___ Limited Liability Partnership
___ Not-for-Profit Corporation
___ Limited Liability Company
___ Limited Partnership
4. State or country of
organization:
_______________________________________
Acquiring Entity (taking over ownership):
5. Business entity name:
_____________________________________________________________________________________
6. Business entity ID
number:
This is not the Federal Employer
ID Number (FEIN)
_______________________________________
7. Type of entity:
___ For-Profit Corporation
___ General Partnership
___ Limited Liability Partnership
___ Not-for-Profit Corporation
___ Limited Liability Company
___ Limited Partnership
8. State or country of
organization:
_______________________________________
9. Effective date:
Upon filing
Future effective date (cannot exceed 90 days from the file date)
__________________________
Month
Day
Year
This interest exchange was approved by the acquired entity in accordance with K.S.A. 17-78-301 through 17-78-306 and
amendments thereto. If the acquired entity is a foreign entity, the interest exchange was approved in accordance with
the laws of the acquired entity’s state or country of origin.
10. Other amendments to the formation document as part of the agreement of interest exchange (if any):
___________________________________________________________________________________________________________
Page 1 of 2
K.S.A . 17-78-301 - K.S.A. 17-78-306
Rev. 12/27/10 jdr
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