60-03 - Certificate Of Manual Signature

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Our fees increased September 1, 2003. Please review the instruction box on the form for the new fee.
CERTIFICATE OF MANUAL SIGNATURE
Print
Reset
Please complete the form, print, sign and
}
STATE OF KANSAS
mail to the Kansas Secretary of State with
ss
the filing fee. Selecting 'Print' will print the
}
form and 'Reset' will clear the entire form.
COUNTY OF _______________
I,
(Please state office held)
of
County, Kansas, being duly sworn, do hereby certify
that the following is my official signature as used in the execution of a
facsimile thereof, prepared and certified in accordance with
Kansas Statutes Annotated 75-4001 to 75-4007.
Signed:
Subscribed and sworn to me this _____ of __________________ , ______ .
Day
Month
Year
Notary Public
My commission expires _______________ .
SEAL
Instruction
This form may be filed free of charge. If you would like a certificate verifing this manual signature please
submit a $10 payment.
Notice: There is a $25 service fee for all returned checks.
60-03
Rev. 8/11/03 amc

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