Form Lc 50 - Limited Liability Company Annual Report - Kansas Secretary Of State
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1Contact Information
KANSAS SECRETARY OF STATE
LC
Kansas Secretary of State
Limited Liability Company Annual Report
Ron Thornburgh
50
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
1. LLC name:
2. Mailing address:
Address
Do not write in this space
City
State
Zip
3. Business Entity ID No.:
(This is not the FEIN)
4. Tax closing date:
Month
Day
Year
5. State of organization:
6. Federal Employer Identification Number (FEIN):
Kansas Limited Liability Companies Only
7. Members who own 5% or more of capital:
Name
Post office address
City
State
Zip
8. I declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and correct and that I have
remitted the required fee.
Executed on the ________ of ________________ , _____________.
Day
Month
Year
Signature of member
Member's name (printed)
Phone number
1/2
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