Form Ine 53-51 - Certificate Of Interest Exchange - Secretary Of State Page 2
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2I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct and that
I have remitted the required fee.
________________________________________________
_______________________
Signature of authorized person representing the acquired entity
Date
________________________________________________
________________________________
Name of signer, printed or typed
Title
i
Instructions:
1. Submit this form with the $75 filing fee. Make checks payable to the Kansas Secretary of State.
There is a $25 service fee for all checks returned by your financial institution.
NOTICE:
Page 2 of 2
Rev. 12/27/10 jdr
K.S.A . 17-78-301 - K.S.A. 17-78-306
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