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 
                                                                                    document will 
            CC       Entity and Foreign Covered Entity                                             not    be accepted for filing.

                       GENERAL FILING 

                       INSTRUCTIONS

n           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.

n           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 _________________________

n           Daytime phone and 
            contact person       ___________________________________________________________________________________
n           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 CT 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.

n           No duplicate copies  Please do not send duplicate copies of your document. The original is processed, and returned to you by 
                                 mail.

n           No email             Filings are not accepted by email.

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

n           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. 5/19/21 nw  

Please
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                                                                Print                                                      Reset
                     kansas secretary of state     
            CC       Certificate of Correction - Kansas Covered Please complete the form, print, sign and mail to the 
                     Entity and Foreign Covered Entity          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                                   For-Profit 53-05
      120 S.W. 10th Avenue                 kssos@ks.gov
                                                                                            Not-For-Profit 53-56
      Topeka, KS 66612-1594                sos.ks.gov
                                                                                            THIS SPACE FOR OFFICE USE ONLY.

      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:

                                           Month     Day   Year
      3b. Date erroneous 
            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

      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. 17-7912                                                                  Please review to ensure completion.
1 / 1       Rev. 5/19/21 nw