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kansas secretary of state All information on the application for registration
Application for Registration of must be complete and accompanied by the
FA Foreign Covered Entity correct filing fee or the document will not be
accepted for filing.

GENERAL FILING

INSTRUCTIONS

Filing fee The filing fee for this document is $115 or $165, depending on the entity type.

Payment Please submit payment by check, money order, or credit card. Checks and money orders need to be
made payable to the Secretary of State. Forms received without the appropriate fee will not be accepted
for filing. Please do not send cash.

Visa, MasterCard, Discover, and American Express are accepted. To use a credit card, please provide
the following information:

Credit card number __________________________________________________________________

Billing zip code _____________________________ Expiration date _________________________

NOTICE: There is a $25 service fee for all returned checks.

Daytime phone and contact
person ___________________________________________________________________________________
Fax filing available Documents may be fax filed for a processing fee of $20 in addition to the normal filing fee. Include contact
name, daytime phone number, credit card number, credit card expiration date and billing zip code.

Fax documents and payment information to Business Services, 785-296-4570. Faxed documents that are
without errors and received prior to 4:00 p.m. CT will receive that day’s file date. Faxed documents received
after 4:00 pm Central Time cannot be guaranteed to receive that day’s filing date.

Filed documents will be returned by mail. You may request a file-stamped copy be faxed for an additional $1
per page. Fax filing does not guarantee same day return faxing.

No duplicate copies Please do not send duplicate copies of documents. The original is processed, file stamped and returned
by mail to the address provided.

No email Filings are not accepted by email.

No filing by phone No documents or reports can be filed with our office by phone.

Public Information All documents filed with our office are available to the public and may be viewed online at www.sos.ks.gov
without cost. Please consider this when providing information on our forms. Instructions and payment
information are not public information and are shredded after use.

K.S.A. 17-7931 Please proceed to form.
Inst. Rev. 10/26/2 2tc

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FA FA FORM
I INSTRUCTIONS

Note: Any foreign covered entity (for profit corporation, not for profit corporation, limited liability company, series
limited liability company, limited partnership, or limited liability partnership) may use this form to apply for authority or
qualification in Kansas.

Question on Form

1. Foreign covered entity name The foreign covered entity name on all documents must be exactly the same as it appears on the
certificate, including punctuation. If the entity applying for authority has the same name as an entity
already on file, you may do one of the following:

• Include a letter of consent from the existing entity to use the name.

• Include a letter stating that the foreign covered entity will list its home state as a means of
identification and in its advertising in the state of Kansas.

The name requirements for foreign covered entities are governed by K.S.A. 17-7933. You may view
statutes at www.ksrevisor.org.

3. Date of formation in home The home state may include this date on the certificate of good standing/existence. Please use the date
state provided by the home state.

4. Original certificate of good The certificate must be an original. We will accept online certificates with a verification code if the home
standing/existence state offers those. We will not accept screen shots of an entity’s status.

* Click here to see each state/jurisdiction’s certificate and issuing agency.

5. Date entity began doing Indicate the date the entity began doing business in Kansas if prior to the filing date. If the entity
business in Kansas began doing business in Kansas more than six months prior to its fiscal year end (question 8), it may
owe annual reports and fees with the application. If more than two annual reports are due, or if more
than 7 months and 15 days have passed from the most recent fiscal year end due and the date of the
application, a penalty fee* of $85 applies to the application fee. All application fees, penalty fees and
annual report fees may be paid with one check.

Example: An entity with a fiscal year end of December that was doing business in Kansas prior to July 1
of the previous year would include one annual report and its filing fee with the application.

To determine reports and fees due, see FA-I Annual Report Fee Schedule attachment for for-profit
entities and not-for-profit corporations.

*Penalty fees do not apply to not-for-profit corporation applications with annual reports due.

6. Resident agent The resident agent is a person or an entity registered with the Kansas Secretary of State that is
authorized to accept service of process (lawsuits) on behalf of the business entity. This does not mean
the agent is being sued, but that the agent has the authority and responsibility to accept service of
process on behalf of the business.

Registered office The registered office is the Kansas street address where the resident agent is located.

11a. Series LLCs This statement applies only if the application is for a series limited liability company.

11b. LLPs This statement applies only if the application is for a limited liability partnership.

12. Signature The signer of the application may be whatever governor (officer, director, authorized person, or partner)
with authority according to the organic documents of the entity in its home state. There is no need to list
a title with the signature.

K.S.A. 17-7931
Inst. Rev. 10/26/2 2tc

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            FA                ANNUAL REPORT 
            I                 FEE SCHEDULE

For-profit entities:
Corporations (use annual report Form AR)
Limited liability companies (use annual report Form LC)
Limited liability partnerships (use annual report Form LLP)
Limited partnerships (use annual report Form LP)
            To determine fees and/or franchise taxes owed, please refer to the chart below for the tax years for which the entity is filing past due 
            annual reports.

            Annual reports with tax year ending DECEMBER 2004 TO PRESENT:

            Franchise tax calculation: N/A

            Minimum amount:            $55 flat filing fee
            Maximum amount:            $55 flat filing fee

            Annual reports with tax year ending 2001 TO NOVEMBER 2004:

            Franchise tax calculation: $2 for every $1,000 of net worth

            Minimum amount:            $55
            Maximum amount:            $5015

            Annual reports with tax year ending PRIOR AND UP TO 2000:

            Franchise tax calculation: $1 for every $1,000 of net worth

            Minimum amount:            $35
            Maximum amount:            $2515

Not-for-profit corporations(use annual report             Form NP):

            To determine fees owed, please refer to the chart below for the tax years for which the corporation is filing past due 
            annual reports.

            Annual reports with tax year ending 2001 TO PRESENT:

            Fee amount:                $40 flat filing fee

            Annual reports with tax year ending 1993 TO 2000:

            Fee amount:                $20 flat filing fee

            Annual reports with tax year ending 1972 TO 1992:

            Fee amount:                $5 flat filing fee

            Annual reports were not filed for not-for-profit corporations PRIOR TO 1972.

              K.S.A. 17-7931
Inst.         Rev. 10/26/2 2tc

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kansas secretary of state Print Reset
Application for Registration of
FA Foreign Covered Entity 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.
Memorial Hall, 1st Floor (785) 296-4564
120 S.W. 10th Avenue kssos@ks.gov
Topeka, KS 66612-1594 sos.ks.gov THIS SPACE FOR OFFICE USE ONLY.

All information on the application for registration must be complete and accompanied by the correct filing fee or the document will
not be accepted for filing. A certificate of existence or good standing from the home state must accompany the application.

Choose type of covered Corporation for profit o Series limited liability company
o
entity: (fee $115) 51-03 (fee $165) 51-33
(Complete statement 11a, if applicable)

o Corporation not for profit o Limited partnership
(fee $115) 51-17 (fee $165) 51-06

o Limited liability company o Limited liability partnership
(fee $165) 51-10 (fee $165) 51-18
(Statement 11b applies)

1. Name of covered entity:
Must exactly match name on
certificate.

2. State or foreign country
of origin:

3. Date of formation in Month Day Year
home state:

4. Include a statement (certificate of good standing/existence*) issued within 90 days of the application by the proper
officer of the jurisdiction where such foreign entity is organized (usually the Secretary of State or comparable
agency) that the entity exists in good standing under the laws of the jurisdiction of its organization.
* Click here to see each state/jurisdiction’s certificate and issuing agency.

5. Date the covered entity Month Day Year See FA-I #5 for additional filings and fees that
began doing business may be due.
in Kansas if prior to the
filing date:

6. Name of resident Name
agent and address of
registered office in
Street Address
Kansas:
Must be a street, rural route,
or highway. A P.O. box is City State Zip
unacceptable.
KS

K.S.A. 17-7931 Please continue to next page.
1 / 2 Rev. 09/26/2 2tc

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7. Mailing address:                  Attention Name
  Address will be used to send
  official mail from the Secretary of
  State’s office.                    Address

                                     City                     State               Zip      Country

8. Fiscal year end:

9. Full nature and character
  of business to be
  conducted in Kansas:

10. The foreign covered entity hereby consents, without power of revocation, that actions may be commenced against
    it in the proper court of any county in the state of Kansas; and the foreign covered entity stipulates and agrees
    that such service shall be taken and held in all courts to be valid and binding as if due service had been made
    upon the authorized persons of the foreign covered entity.

11a. This statement applies to foreign series limited liability companies only, and applies only if the series limited 
    liability company is chosen as type of covered entity.
    The limited liability company is governed by an operating agreement that establishes or provides for the establishment of 
    a series of members, managers, limited liability company interests or assets having separate rights, powers or duties with 
    respect to specified property or obligations of the foreign limited liability company or profits and losses associated with 
    specified property or obligations.
    Check all     The debts, liabilities and obligations incurred, contracted for or otherwise existing with respect to a particular 
    that apply:
                  series, if any, are enforceable against the assets of such series only, and not against the assets of the foreign 
      o           limited liability company generally or any other series thereof.
                  Any of the debts, liabilities, obligations and expenses incurred, contracted for or otherwise existing with respect 
      o           to the foreign limited liability company generally or any other series thereof shall be enforceable against the 
                  assets of such series.

11b. This statement applies to foreign limited liability partnerships only, and applies only if the foreign limited liability 
    partnership is chosen as type of covered entity.
    The above-named partnership elects to be a foreign limited liability partnership.

12.  I declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and correct.
Signature of Authorized Person                            Name of Signer (Printed or Typed)

X

 Please note that information provided on documents filed with the Secretary of State is public record that is subject to 
public access and disclosure (per K.S.A. 45-215 through K.S.A. 45-223).

      K.S.A. 17-7931                                                                       Please review to ensure completion.
2 / 2 Rev. 10/26/2 2tc

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