Form Cc - Certificate Of Correction - Kansas Covered Entity And Foreign Covered Entity - Kansas Secretary Of State

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The following form must be complete and
kansas secretary of state
CC
accompanied by the correct filing fee or the
Certificate of Correction - Kansas Covered
document will not be accepted for filing.
Entity and Foreign Covered Entity
53-___
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
form.
THIS SPACE FOR OFFICE USE ONLY.
1. Business entity ID
number:
Not Federal Employer ID
Number (FEIN).
2. Name of covered entity:
Must match name on record with
Secretary of State.
3a. Specify the document
to be corrected:
Month
Day
Year
3b. Date erroneous
document was filed
with Kansas Secretary
of State:
3c. The inaccuracy needing
correcting:
4. Set forth the portion
of the document in its
corrected form:
5. I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct, and
that I have remitted the required fee.
Signature of Governor
X
Name of Signer (printed or typed)
1 / 1
Please review to ensure completion.
K.S.A. 17-7912
Rev. 1/20/16 tc

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