Form Sc- Registration Statement For Solicitations

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Fees will increase September 1, 2003. If you file this report
before September 1, the fee is $20.00. If you file this report after
September 1, the fee is $35.00.
Contact Information
KANSAS SECRETARY OF STATE
SC
Kansas Secretary of State
Registration Statement for Solicitations
Ron Thornburgh
53-10
Memorial Hall, 1st Floor
All information must be completed or this document will not be accepted for filing.
120 S.W. 10th Avenue
Topeka, KS 66612-1594
(785) 296-4564
Print
Reset
Please complete the form, print, sign and
This report covers the tax year which ended:
mail to the Kansas Secretary of State with
the filing fee. Selecting 'Print' will print
Month
Day
Year
the form and 'Reset' will clear the entire
form.
1. Name of organization:
Do not write in this space
1a. Name/names under which it will solicit:
2. Principal mailing address and street address of the organization:
Street address
City
State
Zip
3. Mailing address of any offices such organization has in Kansas:
Street address
City
State
Zip
4. Purpose for which organization was organized:
5. Names and mailing addresses of any subsidiary or subordinate chapters, branches or affiliates in Kansas:
Name
Street address
City
State
Zip
Name
Street address
City
State
Zip
6. The place where and the date when the organization was legally established:
7. Form of organization: (Trust, Corporation, etc. ):
8. Reference to any determination of tax-exempt status by the Federal Internal Revenue Code of 1986:
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