Free Fund raising package - Kansas

Contact Information
Kansas Secretary of State Ron Thornburgh Memorial Hall, 1st Floor
120 S.W. 10th Avenue
Topeka, KS 66612-1594 (785) 296-4564
[email protected]
www.kssos.org 1. Name of professional fund raiser: 2. Any other names used by the fund raiser:

90-05 KANSAS SECRETARY OF STATE

Professional Fund Raiser Annual Report
All information must be completed or this document will not be accepted for filing.


FR
Reset

Print

Please complete the form, print, sign and mail to the Kansas Secretary of State with the filing fee. Selecting 'Print' will print the form and 'Reset' will clear the entire form.

3. Address:
Street address

Do not write in this space

City

State

Zip

4. Charitable organizations solicited for in the preceding 12 months: Name of organization Address City State Zip

5. Financial information: Name of charitable organization 1 2 3 4 5
(Add additional page if necessary.)

Gross receipts

Solicitation/operating expenses

Net proceeds raised

Net amount to Fee to charitable organization professional fundraiser

1/ 2

6. Methods of fundraising used: Personal contact Volunteers Mail Internet Telephone Vendors Radio TV

Other __________________ specify

7. List names and addresses of professional solicitors (and their ID numbers) retained or employed during the past 12 months, and indicate for which charitable organization(s) they solicited: Name Address City State Zip ID # Charitable org.

(Add additional page if necessary.)

8. Date of this report: _________
Month

________
Day

________
Year

9. Authorized signature(s) (proprietor, or all partners, or corporate officer and title): ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

10. I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct. Executed on this ________ day of ____________________________ , _______ .
Day Month Year

Name (printed or typed)

Authorized signature

Title/position

Instruction This form is to be completed and submitted at expiration of registration or at time of re-registration.
Rev. 4/18/05 jls 2/2 K.S.A. 17-1764

Contact Information
Kansas Secretary of State Ron Thornburgh Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594
(785) 296-4564
[email protected]
www.kssos.org


KANSAS SECRETARY OF STATE

Professional Fund Raiser Operating Statement
All information must be completed or this document will not be accepted for filing.

PO
90-05

Print

Reset

1. Name of professional fund raiser:

______________________________________________
2. Address: _______________________________________
Street address

Please complete the form, print, sign and mail to the Kansas Secretary of State with the filing fee. Selecting 'Print' will print the form and 'Reset' will clear the entire form.

_________________________ ________ ___________
3. Name of charitable organization:

Do not write in this space

______________________________________________
Name

______________________________________ __________________________ ____________ __________
Street address City State Zip

4. Fund raising activity (actual or expected): Beginning date: _______________________
Month

_________________
Day

_____________

Year


Ending date:

_______________________
Month

_________________
Day

_____________

Year


5. Date of this report: _________________________________

I declare (or verify, certify or state) under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct. Executed on this ________ day of ____________________________ , _______ .

Day Month Year


Name (printed or typed)

Authorized signature(s) of professional fund raiser (proprietor, or all partners, or corporate officer and title).

Title/position

Instructions This form must be filed for any charitable organization before acting as a professional fund raiser for the charitable organization.
Rev. 4/20/05 jls K.S.A. 17-1764

Contact Information
Kansas Secretary of State Ron Thornburgh Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594
(785) 296-4564
[email protected]
www.kssos.org
1. Name of professional solicitor: 2. Address:
Street address

KANSAS SECRETARY OF STATE

Professional Solicitor Application
All information must be completed or this document will not be accepted for filing.

PS
90-06

Print

Reset

Please complete the form, print, sign and mail to the Kansas Secretary of State with the filing fee. Selecting 'Print' will print the form and 'Reset' will clear the entire form.
State Zip

City

Do not write in this space

3. Name of professional fund raiser: 4. Address:
Street address City State Zip

5. Date of Application:
Month Day Year

6. I agree to abide by the disclosure requirements of Kansas law, specifically, K.S.A. 17-1766, as set forth below. All solicitations by professional solicitors shall contain the following disclosures at the point of solicitation: (a) The name, address and telephone number of the charitable organization; (b) the registration number, obtained pursuant to K.S.A. 17-1763 for the charitable organization; (c) if the solicitation is made by a person acting as a professional solicitor, the registration number obtained pursuant to K.S.A. 17-1765; and (d) that an annual financial report required by K.S.A. 17-1763 for the preceding fiscal year is on file with the secretary of state.

I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct. Executed on the ________ of ___________ , _____________ .
Day Month Year

Signature of applicant

Signature of professional fund raiser

Instructions 1. Please be sure to enclose the $25 filing fee made payable to the secretary of state with the form. Please do not send cash. 2. This registration/re-registration shall be for a period of one year, or a part thereof, expiring on the 30th day of June and may be renewed upon written application for additional one-year periods. Notice: There is a $25 service fee for all returned checks.
Rev. 8/11/03 jb Rev. 4/20/05 jls K.S.A. 17-1765

Contact Information
Kansas Secretary of State Ron Thornburgh Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594
(785) 296-4564
[email protected]
www.kssos.org
1. Name of professional fund raiser: 2. Any other names used by the fund raiser: 3. Applies for: (Check one) registration re-registration 4. Address of the principal place of business:

KANSAS SECRETARY OF STATE

Professional Fund Raiser Application
All information must be completed or this document will not be accepted for filing.

PR
90-05

Print

Reset

Please complete the form, print, sign and mail to the Kansas Secretary of State with the filing fee. Selecting 'Print' will print the form and 'Reset' will clear the entire form.
Do not write in this space

Street address

City

State

Zip

5. Address of any office or location in Kansas:

Street address

Kansas
City State Zip

6. Form of organization: Sole proprietorship Limited liability company Partnership Limited partnership Corporation Other
describe

7. Names and addresses of officers, directors, partners, members or other persons holding management positions: Names Addresses Title

Instructions

1/2

Rev. 8/11/03 jb

K.S.A. 17-1764

8. Other states in which the fund raiser is registered:

9. Attached hereto are all contracts entered into between me and charitable organizations to act as a professional fund raiser or form PO for each charitable organization. 10. I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct. Executed on the ________ of ______________ , _____________ .

Day Month Year


Signature of applicant

Date of application

Street address

City

State

Zip

Instructions 1. Please enclose the $25 filing fee made payable to the Secretary of State with the form.
Do not send cash.
2. This registration/re-registration shall be for a period of one year, or a part thereof, expiring on the 30th day of June and may be renewed upon written application, under oath, in the form prescribed by the Secretary of State for additional one-year periods. Notice: There is a $25 service fee for all returned checks.
Rev. 4/20/05 jls K.S.A 17-1764 2/ 2