Assertion Of Exemption Form
ADVERTISEMENT
1Kansas Secretary of State, Audit Manager:
kansas secretary of state
Form
Assertion of Exemption
Memorial Hall, 1st Floor
(785) 296-4564
AE
120 S.W. 10th Avenue
audit@sos.ks.gov
Topeka, KS 66612-1594
Directions: This form must be completed in full (typewritten or printed in ink) and signed.
Name of Legal Owner
Phone
Address
City
State
Zip
Common Name of Cemetery
County
Address
City
State
Zip
The above named cemetery claims exemption to the provisions of K.S.A 17-1308, 17-1311, 17-1312, and 17-1312 a to
17-1312e, inclusive, and amendments thereto, based on the following statutory exemption:
Any municipality, corporation or quasi-corporation within the state of Kansas which is empowered to
_______ 17-1312f (a)
issue bonds in payment of which taxes may be levied.
Any nonprofit organization formed primarily for religious purposes and constituting an established
_______ 17-1312f (b)
church and which sells or conveys cemetery lots solely to the members of its own church or to persons
related by consanguinity, either lineal or collateral, by adoption, or by marriage to any such member.
Any cemetery existing on March 1, 1968, located in a county designated as urban, and owned and
_______ 17-1312f (c)
operated on said date by a nonprofit organization.
Any cemetery having a permanent maintenance fund of less that ten thousands dollars ($10,000)
_______ 17-1312f (d)
which was organized prior to January 1, 1900, and which has been maintained and operated
continuously since such date.
I do hereby certify under penalty of perjury and pursuant to the laws of the state of Kansas that the information contained in
this form and supplied in any attachments thereto is true and correct.
Printed Name of Signer
Title
Signature of Owner or Officer
Month
Day
Year
X
1 / 1
Please review to ensure completion.
9/21/12 tc
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal