12. Does this corporation hold more than 50% equity ownership in any other business entity that is registered with the Kansas Secretary
of State?
YES____ Complete the lines below.
NO_____
Skip to question 13.
Please provide the name of the business(es) exactly as recorded with the Kansas Secretary of State and include the Business Entity ID
Number(s) assigned by the Secretary of State (this is not the Federal Employer Identification Number (FEIN)).
Name: ______________________________________________
Business Entity ID Number: _________________________
Name: ______________________________________________
Business Entity ID Number: _________________________
Name: ______________________________________________
Business Entity ID Number: _________________________
Name: ______________________________________________
Business Entity ID Number: _________________________
Name: ______________________________________________
Business Entity ID Number: _________________________
If additional entities exist, please provide an attachment.
13. Does the corporation own or lease land in Kansas that is suitable for use in agriculture?
YES ____ Complete attachment AG
NO ____
Question 13 does not apply to: 1) Tracts of land of fewer than 10 acres; 2) Contiguous tracts of land that are fewer than 10 acres in
aggregate; 3) State assessed railroad operating property.
14. I declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and correct and that I
have remitted the required fee.
Executed on the ________ of __________________ , _____________ .
Day
Month
Year
Name of signer (printed or typed)
Signature of authorized officer
Phone number
Title/Position
2/3