o
Filing fee The ling fee for this document is $165.
o
Payment Please enclose a check or money order payable to the Secretary of State. Applications
received without the appropriate fee will not be accepted for ling. Please do not send cash.
NOTICE: There is a $25 service fee for all checks returned by your nancial institution. Also,
to expedite processing, please do not use staples on your documents or to attach
checks.
o
Resident agent The resident agent is a person or entity that is authorized to accept service of process
(lawsuits) on behalf of the business entity. This does not necessarily mean that the agent
himself/herself is being sued, but that he/she has the authority and responsibility to accept
service of process on behalf of the business.
o
Registered ofce The registered ofce is the address where the resident agent is located.
o
Mailing address The mailing address is where you would like to receive ofcial mail from the Secretary of
State’s Ofce.
o
Signatures The application requires the signature of two partners.
kansas secretary of state
Kansas Limited Liability Partnership
Statement of Qualication
Instructions
Kansas Ofce of the Secretary of State:
Memorial Hall, 1st Floor (785) 296-4564
120 S.W. 10th Avenue kssos@sos.ks.gov
Topeka, KS 66612-1594 www.sos.ks.gov
DLLP
51-12
Inst.
K.S.A. 56a-1001
Rev. 6/2/15 tc
Please proceed to form.
All information on the statement of
qualification must be complete and
accompanied by the correct filing fee or the
document will not be accepted for filing.
Save time and money by filing your statement
of qualification online at www.sos.ks.gov.
There, you can also stay up-to-date on your
organization’s status, annual report due date,
and contact addresses.
Instructions: All information must be completed or this document will not be accepted for ling.
1. Name of the limited
liability partnership
2. Name of resident
agent and address of
registered ofce in
Kansas
Must be a Kansas street
address. A P.O. Box is
unacceptable.
Name
Street Address
City State
KS
Zip
3. Mailing address
Address will be used to send
ofcial mail from the Secretary
of State’s Ofce.
Attention Name
Address
City State Zip Country
4. Tax closing month
5. The above-named partnership elects to be a Kansas limited liability partnership.
6. Effective date
Must be within 90 days of ling.
o
Upon ling
o
Future effective date:
Month Day Year
7. We declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and
correct, and we have remitted the required fee.
Signature of Partner Month Day Year
Signature of Partner Month Day Year
THIS SPACE FOR OFFICE USE ONLY.
1 / 1
K.S.A. 56a-1001
Rev. 6/2/15 tc
kansas secretary of state
Kansas Limited Liability Partnership
Statement of Qualication
Kansas Ofce of the Secretary of State:
Memorial Hall, 1st Floor (785) 296-4564
120 S.W. 10th Avenue kssos@sos.ks.gov
Topeka, KS 66612-1594 www.sos.ks.gov
DLLP
51-12
Please review to ensure completion.
Print
Reset
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.