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