Kansas Register Submission Form printable pdf download

Kansas Register Submission Form

Document No. __________

(For office use only)

Kansas Register Submission Form

Agency Name

Agency Billing Address

Title of Document

Desired Date of Publication

Submitting Authority (name and title)

for publication with notice

Note: The deadline for submission is 4 p.m. Thursday the week before the

desired publication date, and noon Thursday for any item more than 5 typed pages

in length. For more information, contact the Kansas Register Office, 1st Floor,

Memorial Hall, 120 S.W. 10th Ave., Topeka, KS 66612-1594, 785-296-0082.

Please email this form and the document for publication (Microsoft Word attachment) to:

kansasregister@ks.gov

I hereby certify that I have reviewed the attached document and that it conforms to all applicable

Kansas Register publication guidelines and to the requirements of K.S.A. 75-431. I further certify

that submission of this item for publication is a proper and lawful action of this agency, that funds

are available to pay the publication fees, and that such fees will be payed by this agency on receipt of

billing.

Liaison officer's signature

Liaison officer's typed name

Phone

Title

This space for Register office use only

Kansas Register Submission Form