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Please
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kansas secretary of state The following form must be complete and
accompanied by the correct filing fee or the
Kansas Professional Corporation
PA document will not be accepted for filing.
50 Annual Report
Instructions

Kansas Office of the Secretary of State: Save time and money by filing your annual
report online at www.sos.ks.gov. There,
Memorial Hall, 1st Floor (785) 296-4564 you can also stay up-to-date on your
120 S.W. 10th Avenue kssos@sos.ks.gov organization’s status, annual report due date,
Topeka, KS 66612-1594 www.sos.ks.gov and contact addresses.

o Filing fee The filing fee for the annual report is $55. If you are filing this annual report as part of a
reinstatement due to forfeiture, you may owe a different fee (fees are listed with the
reinstatement form). For more information, please call (785) 296-4564.

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 filing. Please do not send cash. NOTICE:
There is a $25 service fee for all checks returned by your financial institution. Also, to
expedite processing, please do not use staples on your documents or to attach checks.

o Mailing address This is the address where you would like to receive official mail from the Secretary of State’s
office. If your address has changed, check the box on the form, so that we may update our
records with your new address.

o Due date Annual reports are due on the 15th day of the fourth month following the tax closing month.
EXAMPLE: If the tax closing month is December, the due date is April 15 of the following
year. The annual report may be filed as early as January 1.

o Forfeiture date If the annual report is not filed and the appropriate fee is not paid within 90 days following the
due date, the business will be forfeited in Kansas. If the forfeited business wishes to return
to active and good standing status, a reinstatement process is required and penalties will be
assessed. EXAMPLE: If the tax closing month is December, the due date is April 15, and the
forfeiture date is July 15. A business must file the annual report and pay the annual report fee
on or before the forfeiture date to avoid forfeiture.

o Corrected annual If you wish to correct information that was erroneously provided on a previously filed annual
report report, you may file a Corrected Document form (form COR). Complete the form and attach a
complete and correct new Annual Report (form PA) and submit with a $55 filing fee.

o Additional information If additional space is needed, please provide an attachment.

K.S.A. 17-2718 Please proceed to form.
Inst. Rev. 6/30/16 tc

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Please
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Print Reset
kansas secretary of state
Kansas Professional Corporation Please complete the form, print, sign and mail to the
PA Kansas Secretary of State with the filing fee. Selecting
50 Annual Report 'Print' will print the form and 'Reset' will clear the entire
form.

Kansas Office of the Secretary of State:

Memorial Hall, 1st Floor (785) 296-4564
120 S.W. 10th Avenue kssos@sos.ks.gov
Topeka, KS 66612-1594 www.sos.ks.gov THIS SPACE FOR OFFICE USE ONLY.

1. Business entity ID number
This is not the Federal Employer ID Number (FEIN).

2. Name of corporation
Must match name on record
with Kansas Secretary of State.

Attention Name Address
3. Mailing address
Address will be used to
send official mail from the City State Zip Country
Secretary of State’s Office.
Do not leave blank.
o Check this box if this is a new address. Our records will be updated only if this box is checked.

Month Year
4. Tax closing date 5. Federal Employer ID
Number (FEIN)

6. Total number of shares
of capital stock issued

Name Title
7. Name, title, and
address of each
officer of corporation Address
If additional space is needed,
please provide attachment.
City State Zip Country
Do not leave blank.

Name Title

Address

City State Zip Country

Name Title

Address

City State Zip Country

K.S.A. 17-2718 Please continue to next page.
1 / 2 Rev. 6/30/16 tc

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Name Address
8. Name and address
of each member of
board of directors of City State Zip Country
corporation
If additional space is needed, Name Address
please provide attachment.
Do not leave blank.
City State Zip Country

Name Address
9. Name and address of
each shareholder
If additional space is needed, City State Zip Country
please provide attachment.
Do not leave blank. Name Address

City State Zip Country

10a. Is each officer, director, and shareholder listed above a qualified person as defined by law (K.S.A. 17-2707)?
Only a qualified person may be a shareholder of a professional corporation (K.S.A. 17-2712). Exception: A certified public accountant (K.S.A. 1-308).
No person may be a director or officer, other than the secretary, of a professional corporation unless that person is a shareholder (K.S.A. 17-2713).
o Yes (Skip to 10c.) o No (Proceed to 10b.)

10b. List those persons who are not qualified as defined by law.

10c. If any shares are owned by a nonqualified person, give the dates on which any shares were owned by a nonqualified person:

11. Indicate the types of professionals practicing through the corporation.
o Architect o Veterinarian o Licensed Physical Therapist o Certified Public Accountant
o Attorney-at-Law o Podiatrist o Landscape Architect o Licensed Physician Assistant
o Chiropractor o Pharmacist o Registered Professional Nurse o Licensed Occupational Therapist
o Dentist o Land Surveyor o Clinical Professional Counselor o Licensed Audiologist
o Engineer o Licensed Psychologist o Geologist o Licensed Speech Pathologist
o Optometrist o Specialist in Clinical Social Work o Clinical Psychotherapist o Licensed Naturopathic Doctor
o Osteopathic Physician or o Physician, Surgeon, or Doctor of o Real Estate Broker or o Clinical Marriage and Family
Surgeon Medicine Salesperson Therapist

12. 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 Authorized Officer

X
Name of Signer (printed or typed) Title/Position Phone Number

K.S.A. 17-2718 Please review to ensure completion.
2 / 2 Rev. 6/30/16 tc

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