Form Car - Cemetery Permanent Maintenance And Merchandise Trust Funds Annual Report Form - Secretary Of State
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KANSAS SECRETARY OF STATE
Contact Information
CAR
Cemetery Permanent Maintenance and
Kansas Secretary of State
Audit Administrator
Merchandise Trust Funds Annual Report
Memorial Hall, 1st Floor
120 S.W. 10th Avenue
Topeka, KS 66612-1594
For Fiscal Year Ending _____/______/______
(785) 296-1848
Cemetery I.D. Number: _______________________
DIRECTIONS: This report must be completed in full (typewritten or printed in ink), signed and filed with the corporate annual report,
which is typically due April 15. For the unincorporated cemetery corporation, this report is due by April 15. If you need additional space
in answering any questions, please attach the information to this form as an Exhibit.
A separate report is required for EACH trust fund.
All cemetery organizations must file, except those that are empowered to issue bonds in payment of which taxes may be levied; nonprofits
formed for religious purposes and constituting an established church that conveys lots only to members or their relatives; nonprofits
existing on March 1, 1968, and located in Johnson County; or those with a permanent maintenance fund of less than $10,000 organized
before January 1, 1900, and operated continuously since that date.
1. Please provide the following contact information regarding the Cemetery:
________________________________________________________________________
Name of Legal Owner
___________________________________________________
__________________________
_____
_______
Mailing Address
City
State
Zip
_________________________________________________________
_______________________________
Common Name of Cemetery
County
___________________________________________________
__________________________
_____
_______
Physical Address
City
State
Zip
___________________________________________________
_________________________
______________
Name of Record Keeper
E-mail Address
Phone
___________________________________________________
__________________________
_____
_______
Mailing Address
City
State
Zip
_________________________________________________________
_______________________________
Name of President
Phone
_________________________________________________________
_______________________________
Name of General Manager
Phone
_________________________________________________________
_______________________________
Name of Treasurer
Phone
_________________________________________________________
_______________________________
Name of Secretary
Phone
Check one: The legal owner is a:
Cemetery organized as a for-profit corporation
_____
Cemetery organized as a not-for-profit corporation
_____
Cemetery organized for religious purposes
_____
Cemetery not a corporation
_____
Other (explain): __________________________________________
K.S.A. 17-1312a; K.S.A. 16-329
Rev. 10/15/10 nr
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