Form Ec 50 - Electric Cooperative Annual Report Page 3
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37. List the names and
1)
_______________________________________________________________________________________
addresses of the board
of directors of the
Name
electric cooperative
_______________________________________________________________________________________ _
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
8. Federal Employer ID
Number (FEIN):
_______________________________________
9. Number of
members:
_______________________________________
10. 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
Rev. 6/01/10 nr
K.S.A . 17-4634
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