Please
Do NotStaple
               kansas secretary of state                           The following form must be complete     and 
                                                                   accompanied by 
               Certificate of Correction - Kansas Covered                                 the correct filing fee or the 
            CC Entity and Foreign Covered Entity                                          not be accepted for filing.
                                                                   document will 

               GENERAL FILING 

               INSTRUCTIONS

Filing fee                  The filing fee for this document is $35 for a for-profit covered entity or $20 for a not-for-profit 
                            covered entity.

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. 

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

                            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 _________________________
Daytime phone and 
contact person              ___________________________________________________________________________________
No duplicate copies         Please do not send duplicate copies of your document. The original is processed, and returned to you by 
                            mail.

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 without cost. Please 
                            consider this when providing information on our forms. Instructions and payment information are shredded 
                            after use.

            K.S.A. 17-7912                                                                Please proceed to form.
Inst.       Rev. 1/1/24 tc  

Please
Do NotStaple
                   kansas secretary of state       
                   Certificate of Correction - Kansas Covered 
            CC     Entity and Foreign Covered Entity

                                                                  Print                        Reset
                                                                                                                                              
      Memorial Hall, 1st Floor             (785) 296-4564         Please complete the form, print, sign and mail to the 
      120 S.W. 10th Avenue                 kssos@ks.gov           Kansas Secretary of State with the filing fee.  Selecting 
      Topeka, KS 66612-1594                https://sos.ks.gov     'Print' will print the form and 'Reset' will clear the entire 
                                                                                               form.

      1.  Business entity ID/file 
            number:

      2.  Name of covered entity:
            Must match name on record with 
            the Secretary of State.

      3a. Specify the document to 
            be corrected:

      3b. Date erroneous                   Month   Day        Year
            document was filed with 
            Kansas Secretary of 
            State:

      3c. The inaccuracy needing 
            correcting:

      4.  Set forth the portion 
            of the document in its 
            corrected form:

      5.  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

            K.S.A. 17-7912                                                                     Please review to ensure completion.
1 / 1       Rev. 1/1/24 tc