Unlicensed Activity Form - State Of Kansas

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Updated 7/2016
STATE OF KANSAS
OFFICE OF ATTORNEY GENERAL DEREK SCHMIDT
BAIL ENFORCEMENT AGENT LICENSING
UNLICENSED ACTIVITY FORM
Mail to:
Bail Enforcement Agent Licensing
Office of Attorney General
th
120 SW 10
Ave
Topeka, Kansas 66612-1597
1. Name of person and/or agency engaging in activities as a bail enforcement agent without a
Kansas license.
Name
___________________________________________________________
(Last name, First Name)
Agency Name
___________________________________________________________
(if applicable)
Address
___________________________________________________________
(Full Street address)
____________________________________________________________
(City)
(State)
(Zip code)
Phone
____________________________________________________________
(area code, number & extension)
2. Name of person providing the information:
Name
___________________________________________________________
(Last name, First Name)
Address
___________________________________________________________
(Full Street address)
___________________________________________________________
(City)
(State)
(Zip code)
Phone
___________________________________________________________
(area code, number & extension)

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