Form Bt 50 - Business Trust Annual Report Page 3
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38. Federal Employer ID
Number (FEIN):
_______________________________________
9. 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 trustee or other authorized officer
Date (month, day, year)
________________________________________________________ ________________________________________________________
Name of signer (printed or typed)
Title/Position
________________________________________________________
Phone number
Page 2 of 2
Rev. 6/01/10 nr
K.S.A . 17-2036
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