o
Filing fee Submit this form with bond and the $40 ling fee.
o
Payment Please enclose a check or money order payable to the Secretary of State. Forms received
without the appropriate fee will not be accepted for ling. Please do not send cash. NOTICE:
There is a $25 service fee for all checks returned by your nancial institution. Also, to expedite
processing, please do not use staples on your documents or to attach checks.
o
Expiration All licenses expire on December 31 of each year. A new application and bond must be
submitted annually.
o
Note Per K.S.A. 82-171, this Act shall not be construed as in any way affecting, altering, or
amending Chapter 34–Grain & Forage. Grain and forage companies operating as public
warehouses are also subject to K.S.A. 34-229.
kansas secretary o f state
Bonded Warehouse License Application
Instructions
Kansas Ofce of the Secretary of State:
Memorial Hall, 1st Floor (785) 296-4564
120 S.W. 10th Avenue [email protected]
Topeka, KS 66612-1594 www.sos.ks.gov
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55
The following form must be complete and
accompanied by the correct filing fee or the
document will not be accepted for filing.
Inst.
K.S.A. 82-163
Rev. 1/5/15 tc
Please proceed to form.
1. Applicant name and
address
Name must be identical on
both application and bond.
Name Street Address
City State Zip
2. Name and address of
ofcers/directors or
partners
If applicant is a corporation,
list names and addresses of
ofcers and directors.
If applicant is a partnership,
list names and addresses of
partners.
Name 1 Street Address
City State Zip
Name 2 Street Address
City State Zip
Name 3 Street Address
City State Zip
3. Place(s) of business
where the applicant
will operate as a
bonded warehouse
Street Address
City State Zip
Street Address
City State Zip
Street Address
City State Zip
4. Percentage of capacity of the warehouse operated as a bonded warehouseman %
5. I declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and
correct and that I have remitted the required fee.
Signature of Person
X
Month Day Year
Name of Signer (printed or typed) Phone Number
THIS SPACE FOR OFFICE USE ONLY.
1 / 1
K.S.A. 82-163
Rev. 1/5/15 tc
kansas secretary o f state
Bonded Warehouse License Application
This form must be complete and accompanied by the correct
filing fee or the document will not be accepted for filing.
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55
Please review to ensure completion.
Print
Reset
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.
Do not write in this space
Know All Persons By These Presents:
That we, _________________________________________________ of
________________________________________________________, as
principal, and _____________________________________________ of
_________________________________________________ , as sureties, are held rmly bound unto the state of Kansas in the sum
of $_______________________, lawful money of the United States, to the payment of which we bind ourselves, our heirs, executors,
administrators and assigns, rmly by these presents. The condition of the above obligation is such that, whereas, the above-bounden
principal, _____________________________________________, was duly licensed to become a bonded warehouseman, and authorized
toadvertise and operate a bonded warehouse for the period ending December 31, _______.
Now, therefore, if the said principal named ______________________________________________________ shall well and faithfully
perform and discharge the duties and responsibilities of a bonded warehouseman, as provided by the laws of the state of Kansas, and of
such additional obligations as a warehouseman which may be assumed by the principal under contract with any owner depositing goods
with the principal or with any purchaser or holder of warehouse receipts issued by the principal, and shall fully comply with all of the
laws of this state relating to bonded warehouses and bonded warehousemen, then this obligation is to be void and of no effect; otherwise
it shall remain in full force and effect.
Executed on the ________ of ______________, ___________.
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KANSAS SECRETARY OF STATE
Warehouseman Bond
All information must be completed and the required fee submitted or this
document will not be accepted for ling. Please read all instructions before
completing this document.
Contact Information
Kansas Secretary of State
Memorial Hall, 1st Floor
120 S.W. 10th Avenue
Topeka, KS 66612-1594
(785) 296-4564
[email protected]
www.sos.ks.gov
Name of signer and title Name of signer
Name of applicant/principal Name of surety
Signature of applicant/principal Signature of surety
Day Month Year
Rev. 1/5/15 tc
K.S.A. 82-165
Notice: There is a $25 service fee for all checks returned by your nancial institution.
1. Submit this form with application and $40 license fee.
2. The amount of bond is based on percentage of capacity of the warehouse operated as a bonded warehouse. The minimum
bond is $5,000 and the maximum bond is $50,000. Example: If 30% of the warehouse is operated as a bonded warehouse, the
bond would be $15,000 (30% of $50,000). The bond must bear the seal of a surety company, must be signed by an attorney in
fact, and must be accompanied by a power of attorney.
Instructions
Name of applicant/principal
City, State of applicant/principal
Name of surety
City, State of surety
Print
Reset
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.