Form Tb-144 - Tobacco Product Distributor Appointment Of Agent For Service Of Process
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2KANSAS DEPARTMENT OF REVENUE
51-25
MISCELLANEOUS TAX
915 SW HARRISON ST.
TOPEKA, KANSAS 66612-1588
Web site:
Email: miscellaneous.tax@kdor.ks.gov
Phone: (785) 368-8222 Fax: (785) 291-3968
TOBACCO PRODUCT
DISTRIBUTOR APPOINTMENT OF
AGENT FOR SERVICE OF PROCESS
DO NOT WRITE IN THIS SPACE
(Name of Firm)
(Must be same as shown on completed Form TB-84)
an individual, partners, a corporation of
(Strike out terms that do not apply)
(City)
(County)
________________________________________________
, a nonresident distributor of tobacco products, as described in Chapter 79,
(State)
Article 33, K.S.A. 1972 Supp., hereby appoints the Secretary of State of the State of Kansas, or his successor in office, to be his true
and lawful agent, upon whom may be served all lawful process in any action or proceeding against said taxes and/or penalties growing
out of the sale of tobacco products in this state; and this appointment shall be evidence of said distributor's agreement that any such
process against said distributor which is so served on the Secretary of State shall be of the same legal force and validity as if served
upon said distributor personally within this state; and as part of this appointment states:
1. Business Name
Address_________________________________________________________________________________________________
(Street or R.F.D.)
(City)
(State)
(County)
(Zip Code)
2. Names and addresses of officers, members or individuals as appropriate:
Name
Title
Address
3. Name and address of individual to whom the Secretary of State of Kansas shall forward any service of process relating to any
matter or issue arising under the above act:
Name
Title
Address
TB-144
(Rev. 6/13)
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