Form K.s.a. 45-220 - Database Records Access Request
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1Kansas Secretary of State
Contact Information
RAR
Database Records Access Request
Kansas Secretary of State
Ron Thornburgh
76 ___
Memorial Hall, 1st Floor
Name _____________________________________________________________
120 S.W. 10th Avenue
Topeka, KS 66612-1594
Address
_____________________________________________________________________
(785) 296-4564
City _________________________________
State _______________
Zip ____________
Phone ____________________
E-mail _____________________________________________
Notice
K.S.A. 21-3914 prohibits using names and addresses derived from public records for
This form is designed to be completed
certain commercial purposes. This includes using public records to sell property or
services. Persons are also prohibited from obtaining public records with the intention
online, printed from your computer and
of making the records available to a third party for such purposes. Violation of this
submitted to the appropritate office.
law is a civil offense punishable by fine. Violations will be referred to the attorney
general or district attorney for prosecution.
Please be sure all pertinent information
is completed before printing. Once the
The undersigned hereby requests access to the records described above and certifies
that the undersigned has a right of access to the records. The undersigned further
form is completed, select 'Print' to print
certifies that the information obtained from the records will not be used for a prohibited
the form. Selecting 'Reset' will clear the
purpose.
entire form.
Sign below to request a record search and to indicate your understanding of the
Do not write in this space
conditions outlined above.
Print
Reset
Signature
Date
Provide database on:
CD-ROM or by
e-mail
_______________________ .
1. Resident agent for active entities:
Resident agent's name:
All: ($150)
RA # :
Formed after: ($150)
Date:
For office use only.
2. Business entity searches for active entities:
To request the entire corporate
For profit corporation ($200)
Limited liability corporation ($150)
database contact the Information
Network of Kansas
Not for profit corporation ($150)
Limited partnership ($150)
(INK) at 1-800-4KANSAS
General partnership ($150)
Limited liability partnership ($150)
3. Other databases:
Charitable organizations ($150)
Notaries ($150)
Fund raisers ($150)
Lobbyists ($50)
• Customized data is available upon request at a rate
Total Amount Due:
$
Sub-total
of $50 per hour plus a $100 information service fee.
• All requests must be paid for in advance and are
$
+
Customized
non-refundable.
Total
$
• Notice: There is a $25 service fee for all returned checks.
Please return with payment to: Secretary of State, Attn: IT Dept., 120 SW 10th Ave., Topeka, KS 66612-1594 or fax to: (785) 368-8031.
Pre-paid account # ____________________________ . For more information e-mail or phone: , (785) 296-6271.
Credit card number: __________________________________
Expiration date: _________________________ ___________
Month
Year
Date received:
Completed by:
Date completed:
Rev. 8/11/03 amc
K.S.A. 45-220
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