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statesecretarykansas                                                                    The following form must be complete    and                            of 
                              Kansas Limited Liability Company                                                     the correct filing fee or the 
                                                                                        accompanied by 
                           KC Certificate of Cancellation                                                          not be accepted for filing.
                                                                                        document will 

                              GENERAL FILING 

                              INSTRUCTIONS

               Filing fee                       The filing fee for this document is $35. There is an additional $20 filing fee for each series 
                                                listed in the attachment.

               Payment                          Please submit payment by check, money order, or credit card. Checks and money orders need to be 
                                                made payable to the Secretary of State.  Forms received without the appropriate fee will not be accepted 
                                                for filing. Please do not send cash. 

                                                Visa, MasterCard, Discover, and American Express are accepted. To use a credit card, please provide 
                                                the following information:

                                                Credit card number __________________________________________________________________

                                                Billing zip code _____________________________   Expiration date _________________________

                                                NOTICE:  There is a $25 service fee for all returned checks.

               Daytime phone and contact 
               person                           ___________________________________________________________________________________
               No duplicate copies              Please do not send duplicate copies of documents. The original is processed, file stamped and returned 
                                                by mail to the address provided.

               No email                         Filings are not accepted by email.

               No filing by phone               No documents or reports can be filed with our office by phone.

               Public information               All information filed with our office is available to the public, and much of it may be viewed online without 
                                                cost. Please consider this when providing information on our forms.

                           K.S.A. 17-7675                                                                          Please proceed to form.
               Inst.       Rev. 5/17/24 tc  



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statesecretarykansas                                                                                                                                                                            of 
                                   Kansas Limited Liability Company 
                           KC      Certificate of Cancellation

                                                                                                  Print Reset
                     Kansas Office of the Secretary of State:                                                                                          
                                                                                                  Please complete the form, print, sign and mail to the 
                     Memorial Hall, 1st Floor             (785) 296-4564                          Kansas Secretary of State with the filing fee.  Selecting 
                     120 S.W. 10th Avenue                 kssos@sos.ks.gov                        'Print' will print the form and 'Reset' will clear the entire 
                     Topeka, KS 66612-1594                https://sos.ks.gov                            form.

                     1.   Business entity ID/file 
                           number:
                           Not Federal Employer ID 
                           Number (FEIN).

                     2.   Name of limited 
                           liability company:*
                           Must match name on record 
                           with Secretary of State.

                                                          *If the limited liability company listed above has filed any certificate of designation to form a series, every series of the limited 
                                                          liability company that has not previously canceled will be canceled with the filing of this form. Use the attachment provided to 
                                                          list all series to be canceled.

                     3.   Reason for 
                           cancellation:

                     4.    I/We declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and 
                           correct. (The signature of one or more authorized persons is required.)
                     Signature of Authorized Person

                     X
                     Name of Signer (Printed or Typed)

                           K.S.A. 17-7675                                                               Please review to ensure completion.
               1 / 1       Rev. 5/17/24 tc  



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statesecretarykansas                                                                                                                                 of 
                                  Kansas Limited Liability Company 
                           KC     Certificate of Cancellation
                                  Attachment

                     This attachment is to be used to list all series that have been formed by the limited liability company listed in Item 2 or the 
                     certificate of cancellation. There is a $20 filing fee for each series listed.
                                                        Name of Series                             ID Number
                     1.   Name and business 
                           entity ID/file number 
                           of each series:              Name of Series                             ID Number
                           (Name must match name on 
                           record with the Secretary of Name of Series                             ID Number
                           State.)

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                                                        Name of Series                             ID Number

                           K.S.A. 17-7675
               Att.        Rev. 1/1/24 tc  






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