Free Gs.p65 - Kansas

Contact Information
Kansas Secretary of State Ron Thornburgh Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594
(785) 296-4564
[email protected]
www.kssos.org


KANSAS SECRETARY OF STATE


General Partnership/Limited Liability Partnership Statement of Dissociation

All information must be completed or this document will not be accepted for filing.


GS

53-14


Print

Reset

1. Name of the partnership:

____________________________________________
Name must match the name on record with the secretary of state

Please complete the form, print, sign and mail to the Kansas Secretary of State with the filing fee. Selecting 'Print' will print the form and 'Reset' will clear the entire form.
Do not write in this space

2. Partner dissociated from the partnership: ____________________________________________________ ____________________________________________________

I/We declare the above-named partner to be dissociated from the general partnership.

I/We 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

If filed by a dissociating partner, the dissociating partner must sign. _________________________________________________
Signature

If filed by the partnership, two partners must sign. _________________________________________________
Signature

______________________________________________________
Signature

Instructions 1. A certified copy of a statement of dissociation filed in another state may be filed instead of this form. 2. Submit this form with the $35 filing fee. Notice: There is a $25 service fee for all returned checks.

Rev. 12/28/04 jls Rev. 8/11/03 K.S.A. 56a-105 K.S.A. 56a-704