Free BW.pmd - 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


KANSAS SECRETARY OF STATE

Bonded Warehouse License Application
All information must be completed and the required fee submitted or this document will not be accepted for filing. Please read all instructions before completing this document.

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1. Name of the applicant: _______________________________________ __________________________________________________________
Street address

__________________________________________________________
City State Zip

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.

(The applicant's name must be identical on both the application and the bond.)

Do not write in this space

2. If the applicant is a corporation, list the names and addresses of the officers and directors below. If the applicant is a partnership, list the names and addresses of the partners below.
Name Title Street address City State Zip

3. Place(s) of business where the applicant will operate as a bonded warehouse.
Street address City State Zip

Percentage of capacity of the warehouse operated as a bonded warehouseman: _________% 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

Instructions 1. Submit this form with bond and the $40 filing fee. 2. All licenses expire on December 31 of each year. A new application and bond must be submitted annually. 3. Per K.S.A. 82-171, this Act shall not be construed as in any way affecting, altering, or amending Chapter 34­Grain & Forage. Grain and forage companies operating as public warehouses are also subject to K.S.A. 34-229. Notice: There is a $25 service fee for all checks returned by your financial institution.
Rev. 12/08/08 jls K.S.A. 82-163