Contact Information
KANSAS SECRETARY OF STATE
SC
Kansas Secretary of State
Registration Statement for Solicitations
Ron Thornburgh
53-10
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
Initial registration
Reset
Print
Renewal/update
Please complete the form, print, sign and
This registration statement covers tax year end ___________________
mail to the Kansas Secretary of State with
Month
Day
Year
the filing fee. Selecting 'Print' will print the
1.a. Name of organization:
form and 'Reset' will clear the entire form.
____________________________________________________
b. Name/names under which it will solicit:
Do not write in this space
____________________________________________________
2.a. Principal street address of the organization:
City
State
Zip
Address
b. Principal mailing address (if different) of the organization:
City
State
Zip
Address
3.a. Principal street address of any offices the organization has in Kansas:
City
State
Zip
Address
b. Principal mailing address (if different) of any offices the organization has in Kansas:
City
State
Zip
Address
4.a. Purpose for which the organization was organized:
____________________________________________________________________________________
b. Purpose for which the organization intends to solicit contributions (if different):
____________________________________________________________________________________
5. Names and mailing addresses of any subsidiary or subordinate chapters, branches or affiliates in Kansas:
Name
Address
City
State
Zip
6. Date of organization ___________________
State of organization ____________________
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