Contact Information
KANSAS SECRETARY OF STATE
CC
Kansas Secretary of State
Corporate Certificate of Correction
Ron Thornburgh
53-05
Memorial Hall, 1st Floor
All information must be completed or this document will not be accepted for filing.
120 S.W. 10th Avenue
Topeka, KS 66612-1594
(785) 296-4564
Print
Reset
Please complete the form, print, sign and
mail to the Kansas Secretary of State with
1. Name of the corporation:
the filing fee. Selecting 'Print' will print
_______________________________________________________
the form and 'Reset' will clear the entire
form.
Name must match the name on record with the secretary of state
2. State of incorporation: ___________________________________
Do not write in this space
3. Specify the document and the inaccuracy that is to be corrected:
___________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
4. Set forth the portion of the document in its corrected form:
____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
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
Signature of authorized officer
Instruction
Submit this form with the $35 filing fee.
Notice: There is a $25 service fee for all returned checks.
Rev. 8/11/03 amc
Rev
. 11/24/04 jls
K.S.A. 17-6003
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