Registration Statement For Solicitations Form - Kansas Secretary Of State Page 4
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420.
Attach copies of the organization’s federal IRS income tax returns (not including schedules listing individual
contributors).
If the organization does not file income tax returns, attach the financial statement prescribed by the Secretary
of State (Form FS) disclosing all fiscal activities of the preceding year.
If the organization received contributions exceeding $500,000 during its fiscal year, attach an audited financial
statement prepared in accordance with generally accepted accounting principles and the opinion of an independent
CPA.
This statement must be signed by two separate, authorized officers, one of whom must be the chief fiscal officer.
I declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and correct and that I have
remitted the required fee.
Executed on this _________ of ___________________________, ____________ .
Day
Month
Year
Signature of authorized officer
Name (printed or typed)
Signature of chief fiscal officer
Name (printed or typed)
___________________________________
Phone number
Instructions
1. Submit this registration statement, along with all required attachments and a $35 registration fee.
2. Solicitation registration expires on the last day of the sixth month following the month in which the fiscal
year of charitable organization ends.
3. Solicitation registration must be renewed each year.
Notice: There is a $25 service fee for all returned checks.
K.S.A. 17-1763
Rev. 8/1/05 nr
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