Form Bw 55 - Bonded Warehouse License Application Page 3
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3KANSAS SECRETARY OF STATE
Contact Information
WB
Kansas Secretary of State
Warehouseman Bond
Memorial Hall, 1st Floor
55
120 S.W. 10th Avenue
All information must be completed and the required fee submitted or this
Topeka, KS 66612-1594
document will not be accepted for filing. Please read all instructions before
(785) 296-4564
completing this document.
kssos@sos.ks.gov
Print
Reset
Please complete the form, print, sign and mail to the
Know All Persons By These Presents:
Kansas Secretary of State with the filing fee. Selecting
'Print' will print the form and 'Reset' will clear the entire
That we, _________________________________________________ of
form.
Name of applicant/principal
________________________________________________________, as
City, State of applicant/principal
principal, and _____________________________________________ of
Do not write in this space
Name of surety
_________________________________________________ , as sureties, are held firmly bound unto the state of Kansas in the sum
City, State of surety
of $_______________________, lawful money of the United States, to the payment of which we bind ourselves, our heirs, executors,
administrators and assigns, firmly by these presents. The condition of the above obligation is such that, whereas, the above-bounden
principal, _____________________________________________, was duly licensed to become a bonded warehouseman, and authorized
toadvertise and operate a bonded warehouse for the period ending December 31, _______.
Now, therefore, if the said principal named ______________________________________________________ shall well and faithfully
perform and discharge the duties and responsibilities of a bonded warehouseman, as provided by the laws of the state of Kansas, and of
such additional obligations as a warehouseman which may be assumed by the principal under contract with any owner depositing goods
with the principal or with any purchaser or holder of warehouse receipts issued by the principal, and shall fully comply with all of the
laws of this state relating to bonded warehouses and bonded warehousemen, then this obligation is to be void and of no effect; otherwise
it shall remain in full force and effect.
Executed on the ________ of ______________, ___________.
Day
Month
Year
Name of applicant/principal
Name of surety
Signature of applicant/principal
Signature of surety
Name of signer and title
Name of signer
Instructions
1. Submit this form with application and $40 license fee.
2. The amount of bond is based on percentage of capacity of the warehouse operated as a bonded warehouse. The minimum
bond is $5,000 and the maximum bond is $50,000. Example: If 30% of the warehouse is operated as a bonded warehouse, the
bond would be $15,000 (30% of $50,000). The bond must bear the seal of a surety company, must be signed by an attorney in
fact, and must be accompanied by a power of attorney.
Notice: There is a $25 service fee for all checks returned by your financial institution.
Rev. 1/5/15 tc
K.S.A. 82-165
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