Kansas Unclaimed Property Extension Request Form

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STATE OF KANSAS
Lynn Jenkins, CPA
TELEPHONE
900 SW JACKSON ST. SUITE 201
TREASURER
(785) 296-3171
TOPEKA, KANSAS 66612-1235
Kansas Unclaimed Property Extension Request
Business Name _____________________________________ Tax ID # ___________________
Business Address _______________________________________________________________
Contact Name ________________________________ Contact Phone # ___________________
Fax # ____________________________________
A copy of the completed request will be faxed to you.
60 days
I am requesting an extension for:
30 days
90 days
The extension period will be added to the filing date requirement.
I am requesting an extension for the filing date:
May 1st (Life Insurance Co)
November 1st
By requesting an extension prior to the filing date the State Treasurer's Office agrees to waive all
interest & penalties described in KSA 58-3967. If you feel that you are unable to meet the
extension date deadline please contact our office.
Return the signed request to:
Unclaimed Property - Holder Services
900 SW Jackson, Suite 201
Topeka, KS 66612-1235
Or fax to:
Holder Department
(785)291-3172
Authorized Business Representative __________________________________ Date _____________
KS Unclaimed Property Representative ________________________________ Date _____________
Extension is approved for time requested.
Extension request is denied for the following reason:
Visit our website at
for report forms, FAQ's and on-line reporting information.
Contact our UCP Holder Department with any questions at (785) 291-3173.

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