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

Note: Please type or print legibly with black ink.

Form

Foreign Limited Liability Company

Cancellation of Authority To Do Business in Kansas

To the Secretary of State for the State of Kansas:

_________________________________________________________________________, a foreign

Name of LLC

limited liability company registered to do business in the State of Kansas pursuant to Kansas law, hereby

cancels its registration.

The cancellation does not terminate the Kansas Secretary of State’s authority to accept service of process

for the limited liability company with respect to causes of action arising out of doing business in the state of

Kansas. 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 that the foregoing is true and correct.

Executed this ____________ day of _______________________, __________ by all members.

Year

Signatures of members:

__________________________________

_____________________________________

__________________________________

_____________________________________

__________________________________

_____________________________________

__________________________________

_____________________________________

This document must be submitted in duplicate

along with a $20 filing fee, and mailed to:

Ron Thornburgh

Secretary of State

First Floor, Memorial Hall

120 S.W. 10th Ave.

Topeka, KS 66612-1594

(785) 296-4564

For general information and forms request, please call: (785)296-4564

If you have comments or suggestions, you may e-mail us at:

This form may be downloaded from our web site at:

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