Form Pa - Professional Corporation Annual Report, Franchise Tax Computation Work Sheet 2002
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1
2
3Contact Information
KANSAS SECRETARY OF STATE
PA
Kansas Secretary of State
Professional Corporation Annual Report
Ron Thornburgh
Memorial Hall, 1st Floor
All information must be completed or this document will not be accepted for filing.
120 S.W. 10th Avenue
Topeka, KS 66612-1594
(785) 296-4564
Corporation name:
Mailing address:
Street address
City
State
Zip
Corporation ID No.:
Do not write in this space
1. Tax closing date:
Month
Day
Year
2. Due date:
Month
Day
Year
Director
3. Officers:
Name
Residential Address
City
State
Zip
Y/N
Pres.
Sec.
Treas.
4. Board of Directors:
Name (if not listed above)
Residential Address
City
State
Zip
5. Shareholders:
Name
Residential Address
City
State
Zip
6. Except for a professional certified public accountant corporation, only a qualified person may be a shareholder of a professional
corporation (K.S.A. 17-2712). No person may be a director or officer, other than the secretary, of a professional corporation unless
that person is a shareholder (K.S.A. 17-2713).
(a) Is each officer, director and shareholder listed above a qualified person as defined by law (K.S.A. 17-2707)?
YES ___
NO ___
(b) If NO, list those persons who are not qualified as defined by law.
_________________________________________________________
(c) If any shares are not owned by a qualified person, give the dates on which any shares were no longer owned by a
qualified person. ____________________________________________
7. Federal Employer Identification Number: ______________________________________________________________________
8. Telephone No.:
________________________________________________________________________________________
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