Form Fl 51-10 - Foreign Limited Liability Company Application - Kansas Secretary Of State - 2017 Page 4

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kansas secretary of state
FA
Application for Registration of
Please complete the form, print, sign and mail to the
Foreign Covered Entity
Kansas Secretary of State with the filing fee. Selecting
'Print' will print the form and 'Reset' will clear the entire
form.
Memorial Hall, 1st Floor
(785) 296-4564
120 S.W. 10th Avenue
kssos@ks.gov
Topeka, KS 66612-1594
THIS SPACE FOR OFFICE USE ONLY.
Return file-stamped document to (name and address):
All information on the application for registration must be complete and accompanied by the correct filing fee or the document will
not be accepted for filing. A certificate of existence or good standing from the home state must accompany the application.
Choose type of covered
o
Corporation for profit
o
Series limited liability company
entity:
(fee $115) 51-03
(fee $250) 51-33
(Statement 10a applies)
o
Corporation not for profit
o
Limited partnership
(fee $115) 51-17
(fee $165) 51-06
o
Limited liability company
o
Limited liability partnership
(fee $165) 51-10
(fee $165) 51-18
(Statement 10b applies)
1. Name of covered entity:
(17-7931(a))
Must exactly match name on
certificate.
2. State or foreign country
of origin:
(17-7931(b))
Month
Day
Year
3. Date of formation in
home state:
(17-7931(c))
4. Include a statement (certificate of good standing/existence*) issued within 90 days of the application by the proper
officer of the jurisdiction where such foreign entity is organized (usually the Secretary of State or comparable
agency) that the entity exists in good standing under the laws of the jurisdiction of its organization.
(17-7931(d))
Click here to see each state/jurisdiction’s certificate and issuing agency.
*
1 / 2
Please continue to next page.
K.S.A. 17-7931
Rev. 12/15/17 tc

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