Kansas Foreign Corporation Dissolution Form

To apply for the cancellation of a foreign corporation, official agent must use this form. Upon completion, agent must attach the $35.00 filing fee to the form and mail it to this address: ____________________.Download

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Above space is for office use only.	
    _______________________________________	
CONTACT:	  Kansas Office of the Secretary of State	
Memorial Hall, 1st Floor
120 S.W. 10th Avenue
Topeka, KS 66612-1594	 	
(785) 296-4564
[email protected]
www.sos.ks.gov	
FW
53-04	
KANSAS SECRETARY OF STATE
Foreign Corporation Certificate
of Withdrawal	
INSTRUCTIONS:  	All information must be completed or this document will not be accepted for filing. 	 	
Please read instructions before completing.	i	
1.  Business entity ID number:This is not the Federal Employer ID Number (FEIN)
2.  Name of corporation:Name must match the name on record with the Secretary of State	
K.S.A	. 17-7306	Rev. 12/28/10 jdr
________________________________________________________    ____________\
_________________________________________	_ __	             	 	Signature of authorized officer                Date (month, date, year)                   	                                    ________________________________________________________   	  	      Name of signer (printed or typed)                                   
7.  I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct and I 
have remitted the required fee. 	  	
Instructions:	  	
1.  	If this form is submitted after the close of the entity’s tax year, an annual report and fee must be filed along   	
 with or prior to dissolution.  If the entity has forfeited, it must reinstate before withdrawal.  
2. Submit this form with the 	$35	 filing fee.   	
STAY UP-TO-DATE ON YOUR ORGANIZATION’S STATUS, ANNUAL REPORT DUE DATE AND CONTACT ADDRESSES BY GOING TO WWW.SOS.KS.GOV.  UNDER QUICK LINKS, SELECT SEARCH BUSINESS ENTITY INFORMATION. 
NOTICE: 	There is a $25 service fee for all checks returned by your financial institution.	 	All information must be completed or this document will not be accepted for filing.  	
Upon filing
Future effective date	_____________________________	_ 	   Month               Day                     Year          	
4.  The Secretary of State may mail any legal process against the corporation to:Address must be a street address. A P.O. box is unacceptable	
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_______________	_  	   Name          Street Address
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______	____	____ 	   City                                State                      Zip                                                      	
3.  State of incorporation:
5.  The corporation surrenders its authority to transact business in the state of Kansas and withdraws therefrom.
6.  Effective date:A future effective date must be within 90 days of filing date	
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Save time and money by filing your withdrawal online at www.sos.ks.gov