Form Fs 64-77 - State Of Kansas Flag - Order Form: Shipped - Kansas Secretary Of State Elections

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kansas secretary of state elections
FS
State of Kansas Flag
Order Form: Shipped
64-77
Kansas Office of the Secretary of State:
Memorial Hall, 1st Floor
TEL: (785) 368-6356
120 S.W. 10th Avenue
FAX: (785) 291-3051
Topeka, KS 66612-1594
matt.cates@sos.ks.gov
THIS SPACE FOR OFFICE USE ONLY.
1. Name
Name
2. Address
Address
City
State
Zip
3. Phone number
4. Credit card number
5. Type
Expiration Date (MM/YYYY)
CVV Code
Visa c
Mastercard c
Discover c
Flags
Quantity
Price
Total
Fund
64-77
4’ x 6’ Nylon
$40.00
01
$0.00
3’ x 5’ Nylon
$30.00
03
$0.00
8” x 12” Rayon with stick
$6.00
06
$0.00
4” x 6” Rayon with stick
$2.50
07
$0.00
Flag stands (for 4” x 6” flag)
$0.50
08
$0.00
Certificate for flying flag
$5.00
60-32
$0.00
Subtotal 4
$0.00
* Sales tax must be paid by all Kansas residents unless specifically exempted (To compute
Shipping 4
$5.00
60-26
correct tax, go to then look up the tax rate by using your mailing
* Tax 4
95-01
address above.) P.O. Boxes are not allowed. There is a $25 service fee for all returned checks.
Total 4
$5.00
To fly flags over the Capitol, please provide the following information:
Date flag should be flown:
Person(s)/organization requesting to fly the flag:
Person(s)/organization for whom the flag is being flown:
Special occasion (if applicable)
1 / 1
Please review to ensure completion.
K.S.A. 75-419
Rev
. 5/10/17 tc

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