Form At - Certificate Of Amendment/termination To Certificate Of Llc Merger Or Consolidation Form - State Of Kansas
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1Kansas Secretary of State
AT
Certificate of Amendment/Termination to Certificate of LLC Merger or Consolidation
All information must be completed or this document will not be accepted for filing.
1. Identify the certificate of merger or consolidation and the
agreement of merger or consolidation affected:
____________________________________________
____________________________________________
____________________________________________
2. State whether the agreement of merger or consolidation
has been amended or terminated.
____ Amended
____ Terminated
3. If the merger has been amended, state the amendment to
Do not write in this space
the certificate of merger:
____________________________________________
____________________________________________
____________________________________________
I 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
____________________________________________
Authorized Person
INSTRUCTIONS:
1. This certificate may only be filed if the certificate of merger or consolidation provided for a future effective
date and this certificate is filed prior to the effective date.
2. Please submit this form in duplicate with the $20 filing fee.
Contact Information
Kansas Secretary of State
Ron Thornburgh
Memorial Hall, 1st Floor
120 SW 10th Avenue
Topeka, KS 66612-1240
785-296-4564
Rev. 7/01 hb
K.S.A. 17-7681
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