Form Lc 50 - Limited Liability Company Annual Report Page 2
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1
2kansas secretary of state
Lc
Limited Liability company
Annual Report
50
Kansas Office of the Secretary of State:
Memorial Hall, 1st Floor
(785) 296-4564
120 S.W. 10th Avenue
kssos@sos.ks.gov
Topeka, KS 66612-1594
THIS SPACE FOR OFFICE uSE ONLY.
1. Business entity iD #
This is not the Federal Employer ID
Number (FEIN).
2. LLc name
Must match name on record with
Kansas Secretary of State.
3.
Mailing address
Attention Name
Address
Address will be used to
send official mail from the
City
State
Zip
Country
Secretary of State’s Office.
Do not leave blank.
o
Check this box if this is a new address. Our records will be updated only if this box is checked.
4.
tax closing date
5.
State of organization
Month
Year
6.
Name and address
Name 1
Address
of each member who
owns 5% or more of
City
State
Zip
Country
capital (Kansas LLc
only)
If additional space is needed,
Name 2
Address
please provide attachment.
City
State
Zip
Country
Name 3
Address
City
State
Zip
Country
7.
Federal Employer Identification Number (FEIN)
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.
Signature of Member
Month
Day
Year
X
Name of Signer (printed or typed)
Phone Number
1 / 1
Please review to ensure completion.
K.S.A. 17-76,139
Rev. 9/12/11 jdr
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