Form Bw 55 - Bonded Warehouse License Application
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1KANSAS SECRETARY OF STATE
Contact Information
BW
Kansas Secretary of State
Bonded Warehouse License Application
Ron Thornburgh
55
Memorial Hall, 1st Floor
All information must be completed and the required fee submitted or this
120 S.W. 10th Avenue
document will not be accepted for filing. Please read all instructions before
Topeka, KS 66612-1594
completing this document.
(785) 296-4564
Print
Reset
1. Name of the applicant: _______________________________________
Please complete the form, print, sign and
mail to the Kansas Secretary of State with
__________________________________________________________
the filing fee. Selecting 'Print' will print the
Street address
form and 'Reset' will clear the entire form.
__________________________________________________________
City
State
Zip
Do not write in this space
(The applicant’s name must be identical on both the application and the bond.)
2. If the applicant is a corporation, list the names and addresses of the officers and directors below. If the applicant is a partnership, list the
names and addresses of the partners below.
Name
Title
Street address
City
State
Zip
3. Place(s) of business where the applicant will operate as a bonded warehouse.
Street address
City
State
Zip
Percentage of capacity of the warehouse operated as a bonded warehouseman: _________%
I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct.
Executed on the ________ of ______________, ___________.
Day
Month
Year
_______________________________________________
Signature
Instructions
1. Submit this form with bond and the $40 filing fee.
2. All licenses expire on December 31 of each year. A new application and bond must be submitted annually.
3. Per K.S.A. 82-171, this Act shall not be construed as in any way affecting, altering, or amending Chapter 34–Grain & Forage.
Grain and forage companies operating as public warehouses are also subject to K.S.A. 34-229.
Notice: There is a $25 service fee for all checks returned by your financial institution.
Rev. 12/08/08 jls
K.S.A. 82-163
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