Form Np 50 - Not-For-Profit Corporation Annual Report Page 2
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38. List the names and
1) _______________________________________________________________________________________
addresses of the
governing body of the
Name
corporation:
_______________________________________________________________________________________ _
Do not leave blank
Address
City
State
Zip
Country
If additional space is needed
2) _______________________________________________________________________________________
please provide an attachment
Name
________________________________________________________________________________________ _
Address
City
State
Zip
Country
3) ______________________________________________________________________________________
Name
________________________________________________________________________________________ _
Address
City
State
Zip
Country
9. Federal Employer ID
_______________________________________
Number (FEIN):
10. Total number of
shares of capital stock
issued:
Must be a numeric value;
_______________________________________
“NA” is not acceptable
11. Total number of
memberships:
Must be a numeric value;
“NA” is not acceptable
_______________________________________
12a. Does this corporation
YES ____ Complete question 12b.
hold more than 50% equity
ownership in any other
NO____ Skip to question 13.
business entity that is filed
with the Kansas Secretary
of State?
12b. Please provide the
________________________________________________________________________________________
name of the business(es)
exactly as filed with the
Business entity name
Business entity ID number
Kansas Secretary of State
________________________________________________________________________________________
and include the Business
Business entity name
Business entity ID number
Entity ID Number(s)
assigned by the Secretary
________________________________________________________________________________________
of State.
Business entity name
Business entity ID number
This is not the Federal Employer
ID Number (FEIN)
*If additional entities exist, please provide an attachment.
13. Does the corporation own or lease land in Kansas
YES____ Complete attachment AG.
that is suitable for use in agriculture?
This question does not apply to:
NO____
1) Tracts of land of fewer than 10 acres
2) Contiguous tracts of land that are fewer than 10 acres in aggregate
3) State-assessed railroad operating property
14. 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.
Do not leave blank.
________________________________________________________ ________________________________________________________
Signature of authorized officer
Date (month, day, year)
________________________________________________________ ________________________________________________________
Name of signer (printed or typed)
Title/Position
________________________________________________________
Phone number
Page 2 of 2
K.S.A . 17-7504
Rev. 6/01/10 nr
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