Please
Do NotStaple
                       kansas secretary of state     
                       Annual Report
            LC         Limited Liability Company or Series

                                                                                                  SUBMIT THE DOCUMENTS 
                                                                                                           WITHOUT THIS PAGE
                 INSTRUCTIONS FOR FILING

                       AN ANNUAL REPORT

Series of an LLC must submit this form for the annual report and can’t be filed online.

Note: All documents filed by the Secretary of State’s office is considered public record and may be viewable online. File 
this document directly online at https://www.kansas.gov/annual-reports/index.do.

How to complete the annual report for an LLC:                                      Fee Schedule

Each of the numbered instructions below corresponds to a section on                Annual Report
the form.
                                                                                   The filing fee for the annual report is as follows:
1.  List the entity’s ID number issued by the Kansas Secretary of 
            State (this is not a tax ID number). ID numbers may be found by        Online Annual Report: ................................... $53
            clicking on Business Entity Database at https://www.kansas.gov/        Paper Annual Report: .................................... $55
            bess/.

2.  Provide the complete legal entity name, including words of                     Filing Online
            formation (e.g., LLC, Inc., etc.)
                                                                                   The annual report may be filed directly online at https://www.kansas.
3.  Provide the principal office of the entity.                                    gov/annual-reports/index.do.

            Principal office: Must be a physical address that must include the 
            building number, street, city, state, and zip code. This can’t be a PO Mail to:
            box.
                                                                                   Kansas Secretary of State
4.  Provide the tax closing date for the annual report. Annual reports             Memorial Hall, 1st Floor
            are filed after a tax year end has passed and represent the            120 SW 10th Avenue
            information that is true for that year end only (example:  when an     Topeka KS 66612
            entity’s tax year ends on the last day of December, the annual 
            report due date period would be between January 1st and April          Only checks are accepted for payment. Make checks payable to the 
            15th after each December. The report should reflect December for       Kansas Secretary of State.
            the month).
                                                                                   Or
5.  Domestic (Kansas) entities only: Each member of the LLC who 
            owns 5% or more of the capital must be named along with the            Fax to:
            address where they may be regularly located.
                                                                                   This form can’t be faxed unless it is being filed as part of another filing 
6.  An authorized person on behalf of the entity must sign.                        (i.e., reinstatement, corrected document, foreign application, etc.) See 
                                                                                   the fax instructions with the other document for details.

                  K.S.A. 17-76,139                                                                             Please proceed to form.
Inst.             Rev. 7/10/23 tc

Please
Do NotStaple
                        kansas secretary of state                                           Print                                Reset
            LC          Annual Report                                                                                                            
            50          Limited Liability Company or Series                                 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.
      Memorial Hall, 1st Floor             (785) 296-4564  
      120 S.W. 10th Avenue                 kssos@ks.gov
      Topeka, KS 66612-1594                sos.ks.gov
                                                                                                  THIS SPACE FOR OFFICE USE ONLY.

      1.   Business entity ID/file         Kansas Secretary of State issued 
            number:                        file number.

      2.   Name of LLC or                  Must match name on record with 
              series:                      Kansas Secretary of State.

                                           Street Address (A PO box is unacceptable.)
      3.   Principal office 
            address:
            Must be a street, rural route  City                                      State  Zip   Country
            or highway. A PO box is 
            unacceptable.

                                           Month          Year
      4.   Tax closing date:

                                           Name                                      Address
      5.   Name and address 
            of each member who 
            owns 5% or more                City                                      State  Zip   Country
            of capital (Kansas 
            Limited Liability 
            Companies or Kansas            Name                                      Address
            series only):
                                           City                                      State  Zip   Country

                                           Name                                      Address

            If additional space is needed, City                                      State  Zip   Country
            please provide attachment.

      6.    I declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and 
            correct.
      Signature of Authorized Person (Required)

      X
      Name of Signer (printed or typed)                                                           Phone Number (Not required)

            K.S.A. 17-76,139                                                                      Please review to ensure completion.
1 / 1       Rev. 7/10/23 tc