Form Ca 53-02 - Foreign Limited Liability Company Cancellation Of Authority To Do Business In Kansas - 2004

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Our fees increased September 1, 2003. Please review
the instruction box on the form for the new fee.
KANSAS SECRETARY OF STATE
Contact Information
CA
Foreign Limited Liability Company
Kansas Secretary of State
Cancellation of Authority to do Business in Kansas
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
the filing fee. Selecting 'Print' will print
Name of the limited liability company:
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
a foreign limited liability company registered to do business in the state of Kansas pursuant to Kansas law, hereby cancels its registration.
Service of process may be forwarded to the limited liability company at the following address:
Address must be a street address. A post office box is unacceptable.
__________________________________________________
_______________________
_____________
____________
Street Address
City
State
Zip
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
Signatures of all members:
Instructions
1. Submit this form in duplicate with the $35 filing fee.
2. If this form is submitted after the close of the corporation’s tax year, an annual report and franchise tax
must be submitted for that year.
Notice: There is a $25 service fee for all returned checks.
Rev. 4/05/04 amc
K.S.A. 17-76,125

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