Form Ec 50 - Electric Cooperative Annual Report Page 2
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3KANSAS SECRETARY OF STATE
EC
Electric Cooperative
50
Annual Report
Kansas Secretary of State, Chris Biggs
CONTACT:
Memorial Hall, 1st Floor
(785) 296-4564
120 S.W. 10th Avenue
Topeka, KS 66612-1594
Above space is for office use only.
All information must be completed or this document will not be accepted for filing.
INSTRUCTIONS:
i
Please read instructions sheet before completing.
1. Business entity ID
number:
This is not the Federal Employer
_______________________________________
ID Number (FEIN)
2. Electric Cooperative
name:
Name must match the name on
________________________________________________________________________________________
record with the Secretary of State
3. Mailing address:
________________________________________________________________________________________
This address will be used to send
Attention Name
Address
official mail from the Secretary
of State’s office
_______________________________________________________________________________________
City
State
Zip
Country
Do not leave blank
Check this box if this is a new address. Our records will be updated ONLY if this box is checked.
4. Principal office
address:
________________________________________________________________________________________
Must be a street, rural route or
Street Address
highway; a P.O. box is
unacceptable
_______________________________________________________________________________________
City
State
Zip
Country
5. Tax closing date:
______________________________
Month
Year
6. List the names, titles
1)
and addresses of all
______________________________________________________________________________________
officers of the
Name
Title
electric cooperative:
Do not leave blank
_______________________________________________________________________________________
Address
City
State
Zip
Country
If additional space is needed
2)
please provide an attachment
______________________________________________________________________________________
Name
Title
__________________________________________________________________________________________
Address
City
State
Zip
Country
3)
_____________________________________________________________________________________
Name
Title
____________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Address
City
State
Zip
Country
Page 1 of 2
K.S.A . 17-4634
Rev. 6/01/10 nr
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