Please
Do NotStaple
                 kansas secretary of state                                       The following form must be complete and 
                                                                                 accompanied by the correct filing fee or the 
            LC   Limited Liability Company or                                    document will not be accepted for filing.
            50   Series Limited Liability Company
                 Annual Report

                                                                                 Save time and money by filing your forms online 
                                                                                 at sos.ks.gov. There, you can also stay up-to-
                 GENERAL FILING                                                  date on your organization’s status, annual report 
                                                                                 due date, and contact addresses.
                      INSTRUCTIONS

      Filing fee             The filing fee for the annual report is $55.  If you are filing this annual report as part of a  
                             reinstatement due to forfeiture, you may owe a different fee (fees are listed with the reinstatement 
                             form).  For more information, please call (785) 296-4564.

      Payment                Please enclose a check or money order payable to the Secretary of State. Forms received without 
                             the appropriate fee will not be accepted for filing. Please do not send cash. NOTICE:  There is a 
                             $25 service fee for all checks returned by your financial institution. Also, to expedite processing, 
                             please do not use staples on your documents or to attach checks.

      Due date               The annual report shall be filed at the time prescribed by law for filing the annual Kansas tax 
                             return.  

      Forfeiture date        If the annual report is not filed and the appropriate fee is not paid within 90 days following the due 
                             date, the business will be forfeited in Kansas. If the forfeited business wishes to return to active 
                             and good standing status, a reinstatement process is required and penalties will be assessed. 
                             EXAMPLE:  If the tax closing month is December, the due date is April 15, and the 
                             forfeiture date is July 15.  A business must file the annual report and pay the annual report fee on 
                             or before the forfeiture date to avoid forfeiture.  

      Amending annual        If you wish to correct information that was erroneously provided on a previously filed annual report, 
      reports                file a completed Corrected Document form COR with a complete and correct new Annual Report 
                             form LC and submit with a $55 filing fee. 

      Additional information If additional space is needed, please provide an attachment.

      Domestic and foreign   Use this form to file for both domestic or foreign entities.

      Public information     All documents filed with our office are available to the public and may be view online at www.sos.
                             ks.gov without cost. Please consider this when providing information on our forms. Instructions and 
                             payment information are not public information and are shredded after use.

            K.S.A. 17-76,139                                                                        Please proceed to form.
Inst.       Rev. 02/08/23 tc

Please
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                                                                                          Print                                Reset
                     kansas secretary of state         
            LC       Limited Liability Company or                                                                                              
            50       Series Limited Liability Company                                     Please complete the form, print, sign and mail to the 
                                                                                         Kansas Secretary of State with the filing fee.  Selecting 
                     Annual Report
                                                                                   '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             This is not the Federal Employer ID 
            number                             Number (FEIN).

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

                                               Month         Year
      3.   Tax closing date

                                               Name                                Address
      4.   Name and address 
            of each member who 
            owns 5% or more of                 City                                State  Zip   Country
            capital*
            If additional space is needed,     Name                                Address
            please provide attachment.
                                               City                                State  Zip   Country
            *Foreign (non-Kansas) 
            LLCs are not required to list 
            membership and may skip            Name                                Address
            this question.
                                               City                                State  Zip   Country

      5.    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)

      Please note that information provided on documents filed with the Secretary of State is public record that is subject to public access 
      and disclosure (per K.S.A. 45-215 through K.S.A. 45-223).

            K.S.A. 17-76,139                                                                    Please review to ensure completion.
1 / 1       Rev. 02/08/23 tc