Form Pa - Professional Corporation Annual Report, Franchise Tax Computation Work Sheet 2002 Page 2
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39.
Number of Shares Issued
Total Amount of Stock Paid Up
$
$
$
$
10. Indicate the types of licensed professionals who practice through the corporation:
____ Architect
____ Engineer
____ Physician, surgeon or doctor of medicine
____ Attorney-at-law
____ Geologist
____ Podiatrist
____ Certified Public Accountant
____ Land architect
____ Real estate broker or salesperson
____ Chiropractor
____ Land surveyor
____ Registered physical therapist
____ Clinical marriage & family therapist
____ Licensed psychologist
____ Registered professional nurse
____ Clinical professional counselor
____ Optometrist
____ Specialist in clinical social work
____ Clinical psychotherapist
____ Osteopathic physician or surgeon
____ Veterinarian
____ Dentist
____ Pharmacist
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
Name of signer (printed or typed)
Authorized Signature
Title/Position
Instructions
1. Be sure to complete all applicable items to the best of your knowledge. Use zeros and N/A if needed.
2. DUE DATE-Annual reports are due when the Kansas annual income tax report is due, generally the 15th day
of the fourth month following the close of the tax period. State law provides that, in addition to penalties, the
failure to file the annual report or to pay its annual taxes within 90 days of the time for filing and
paying will result in the forfeiture of the corporation in Kansas. The annual report must be filed every year
if the corporation wishes to remain in good standing in Kansas.
3. EXTENSIONS-An extension of the filing deadline may be obtained by submitting a copy of an application for
an extension of time for filing a Kansas or federal income tax return. The request for extension must be filed not
more than 90 days after the due date of the annual report. No payment is necessary until the report is filed.
4. INTERIM REPORT-An interim report must be filed if the tax period changes. The franchise tax for an
interim report can be prorated for the number of months the report covers. However, there is a minimum fee of
$40.00. An interim report cannot be filed for a period greater than 12 months from the date of the last report filed.
5. AMENDED REPORT-If this is an amended report, indicate by printing “amended” at the top of the first
page.
6. Please be sure to enclose a check with the annual report. Make checks payable to Secretary of State. Do not
send cash.
Rev. 12/03/02 ac
K.S.A. 17-2718
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