Free PMF - Kansas


File Size: 65.6 kB
Pages: 1
Date: September 24, 2007
File Format: PDF
State: Kansas
Category: Secretary of State
Author: nancyr
Word Count: 306 Words, 2,736 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.kssos.org/forms/Administration/CER.pdf

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Contact Information
Kansas Secretary of State Audit Administrator
Memorial Hall, 1st Floor
120 S.W. 10th Avenue Topeka, KS 66612-1594 (785) 296-1848 [email protected]
www.kssos.org


Please complete the form, print, sign and mail to the Kansas Secretary of State. Selecting 'Print' will print the form and 'Reset' will clear the entire form. KANSAS SECRETARY OF STATE

Cemetery Registration

CER

Directions: This form must be completed in full (typewritten or printed in ink), signed and returned. If additional space is needed in answering any questions, please attach the information to this form as an Exhibit.

1. Please provide the following contact information regarding the Cemetery: _____________________________________________________
Name of Legal Owner

_______________________
E-mail Address

__________________
Phone Number

_____________________________________________________
Address

_______________________
City

______
State

__________
Zip

_____________________________________________________________
Common Name of Cemetery

___________________________________
County

_____________________________________________________
Physical Address

_______________________
City

______
State

__________
Zip

2. Please answer the following Cemetery questions: a. If incorporated, give state of incorporation: ___________________________ b. Give date of establishment: ___________________________ c. If incorporated outside of Kansas, give date granted authority in Kansas: ___________________________ d. Has the cemetery operated continuously since establishment? Yes ____ No ____ No ____

e. Is the cemetery a municipality or otherwise empowered to issue bonds or levy taxes? Yes ____

f. Does the cemetery constitute an established church and convey lots only to members and/or their relatives?
Yes ____ No ____
g. The legal owner is a: Cemetery organized as a for-profit corporation ______ Cemetery organized as a not-for-profit corporation ______ Cemetery organized for religious purposes ______ ______ Cemetery not a corporation Other (explain): _____________________________________________________________________________ h. Give amount currently in permanent maintenance trust fund: $___________________________ I do hereby certify under penalty of perjury and pursuant to the laws of the state of Kansas that the information contained in this form and supplied in any attachments thereto is true and correct. __________________________________________________________
Signature of Owner or Officer

________________________
Date

__________________________________________________________
Printed Name of Signer 6/15/07 nr

________________________
Title K.S.A. 17-1312a; K.S.A. 17-1312f 1/1