Our fees increased September 1, 2003. Please review the instruction box on the form for the new fee. Contact Information
Kansas Secretary of State Ron Thornburgh Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594 (785) 296-2239 [email protected] www.kssos.org Applicant's name:
Street address City State Zip
KANSAS SECRETARY OF STATE
Business Agent Registration
All information must be completed or this document will not be accepted for filing.
For your convenience, this form has been designed to be filled out online, printed from your computer and then mailed to our office. Please be sure all pertinent information is filled in before printing. Once the form is completed, select 'Print' to print the form. Selecting 'Reset' will clear the entire form.
Do not write in this space
Applicant desires to operate in Kansas as a business agent for: Organization: Address: Daytime phone number: I am applying for a registration certificate as a business agent of a labor or employee organization. In support of my application, I make the following statements: 1) I am a citizen of the United States. 2) I have been a resident of Kansas for ________________ . Registration as a business agent is valid for the calendar year (Jan. - Dec.) in which it is filed, or the business organization's fiscal year. Please indicate below the expiration date of this registration: a) December 31, ______ or b) ___________ , _______ (end of fiscal year)
Year Month Year
Signature of applicant
Statement of President and Secretary of Organization:
To the secretary of state, state of Kansas: The above-named applicant is duly authorized by (name of organization): ____________________________________ to act as its business agent as such term is defined in sections of K.S.A. 44-802 and 75-4322, as amended.
President (printed or typed) President (signature)
Secretary (printed or typed)
1. Applicant must be a citizen of the United States. 2. Submit registration fee of $20 with application. 3. Any labor organization that has a business agent must file a copy of its constitution and bylaws with the secretary of state before doing business in Kansas. Amendments or changes to the constitution or bylaws must be filed with the secretary of state within 30 days of their adoption.
Notice: There is a $25 service fee for all returned checks.
Rev. 8/11/03 amc K.S.A. 44-804