Document No. __________
Kansas Register Submission Form
Agency Name Agency Billing Address
Title of Document Desired Date of Publication
Note: The deadline for submission is 4 p.m. Thursday the week before desired publication date, and noon Thursday for any item more than 5 typed pages in length. Submit all items (hard copy) in duplicate.
Mail to: Kansas Register Secretary of State Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594
Deliver to: Memorial Hall, 1st Floor Phone (785) 296-3489 Fax (785) 368-8024 e-mail: [email protected]
I hereby certify that I have reviewed the attached document and that it conforms to all applicable Kansas Register publication guidelines and to the requirements of K.S.A. 75-431. I further certify that submission of this item for publication is a proper and lawful action of this agency, that funds are available to pay the publication fees, and that such fees will be payed by this agency on receipt of billing.
Liaison officer's typed name
Liaison officer's signature
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