Form Rn 53-08 - Not For Profit Corporation Certificate Of Reinstatement - 2003

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Contact Information
Kansas Secretary of State
Not for Profit Corporation Certificate of Reinstatement
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
1. The name of the corporation as it existed when the corporation forfeited:
Please complete the form, print, sign and
mail to the Kansas Secretary of State with
the filing fee. Selecting 'Print' will print the
form and 'Reset' will clear the entire form.
2. Address of registered office in Kansas:
Address must be a street address. A post office box is unacceptable.
Do not write in this space
Street address
Name of resident agent at the registered office:
3. The corporation was organized in the state of:
4. The corporate existence or authority to engage in business in the state of Kansas: (select one)
___ Has been forfeited for failure to timely file its annual report and pay its franchise tax.
___ Has expired or will expire on the _____ of ______________ , ________ .
Is this reinstatement perpetual? Yes _____ No _____
If no, the term for which this corporation is to exist _________________ .
___ Has been forfeited for failure to designate or maintain a resident agent and registered office.
This certificate is filed by the authority of duly elected directors or members of the governing body of the corporation in compliance with the
provisions of K.S.A. 17-7002.
I/We (circle one) declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct.
Executed on the ________ of ___________ , _____________
and Attest:
President or vice president
Secretary or assistant secretary
1. Submit this form in duplicate with the $20 filing fee.
2. The last three annual report forms (NP) must be filed with reinstatement.
3. All past due privilage fees must be paid prior to reinstatement.
Notice: There is a $25 service fee for all returned checks.
K.S.A. 17-7002
Rev. 8/26/03 amc


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