Form K.s.a. 17-4634 - Electric Cooperative Annual Report

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Contact Information
KANSAS SECRETARY OF STATE
EC
Kansas Secretary of State
Electric Cooperative Annual Report
Ron Thornburgh
50
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
1. Electric cooperative name:
2. Mailing address:
Address
Do not write in this space
City
State
Zip
3. Location of principal office:
Street address
A post office box is unacceptable.
City
State
Zip
4. Business Entity ID No:
(This is not the FEIN)
5. Tax closing date:
Month
Day
Year
6. Federal Employer ID Number (FEIN):
7. Officers:
Complete information for all three positions.
Name
Residential address
City
State
Zip
Pres.
Sec.
Treas.
8. Board of directors:
Entity must have at least one director.
Name
Residential address
City
State
Zip
1/3

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