Kansas Secretary of State Ron Thornburgh Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594 (785) 296-4564 firstname.lastname@example.org www.kssos.org
KANSAS SECRETARY OF STATE
Database Records Access Request
To request the entire corporate
database contact the
Information Network of Kansas at 1-800-4KANSAS.
1. Contact information (where information will be sent): Name ____________________________________________________ Address __________________________________________________ __________________________________________________
City State Zip
This form is designed to be completed online, printed from your computer and submitted to the appropritate office. Please be sure all pertinent information is completed 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
2. Please read the following notice and sign below if you agree to the terms: K.S.A. 45-230 prohibits using names and addresses derived from public records for certain commercial purposes. This includes using public records to sell property or services. Persons are also prohibited from obtaining public records with the intention of making the records available to a third party for such purposes. Violation of this law is a civil offense punishable by fine. Violations will be referred to the Attorney General or district attorney for prosecution. The undersigned hereby requests access to the records described below and certifies that the undersigned has a right of access to the records. The undersigned further certifies that the information obtained from the records will not be used for a prohibited purpose. Sign below to request a record search and indicate your understanding of the conditions outlined above.
Printed name of signer
3. Preferred method of receiving database:
___ E-mail: _____________________________________
4. Database of resident agents for active business entities on file with the Secretary of State ___________________________
Resident Agent # (for office use)
Name of agent to be searched: ______________________________________________ Agent searched in: 5. ___ all active entities ($150) ___ entities formed after _______________ ($150)
Database of active business entities by type: ___ Limited liability companies ($150) ___ Limited partnerships ($150) ___ Limited liability partnerships ($150) ___ General partnerships ($150)
Other databases available: ___ Charitable organizations ($150) ___ Notaries ($150) ___ Fund raisers ($150)
___ Lobbyists ($50)
___ For-profit business entities ($200) (includes corporations, LLCs, LPs, LLPs, GPs) ___ For-profit corporations ($150) ___ Not-for-profit corporations ($150)
Payment: Submit a check or money order payable to the Secretary of State or provide pre-paid account or credit card information below. All requests must be paid in advance and are nonrefundable. Pre-paid account # ______________ Credit card # (Visa/MC) __________________________________ Exp. date: _______
Date received: __________________ Completed by: _______________________________ Date completed: ____________________
Rev. 9/1/06 nr K.S.A. 45-230