RON THORNBURGH
Secretary of State

STATE OF KANSAS
Memorial Hall, 1st Floor
120 SW 10th Avenue
Topeka, KS 66612-1594
(785) 296-4564
www.kssos.org

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UCC Secured Party Listing Request

By Prepaid Account
 To electronically request a UCC Secured Party listing and you are paying by PREPAID ACCOUNT fill out the following form and click on the SUBMIT button at the bottom of this form.

* Required fields are marked by an asterisk. Your request will be processed by our records department and returned to you via your selected method within 3 business days (allow 7-10 days for U.S. Postal Service). Your account will be charged $150.00. You must provide your PREPAID ACCOUNT # and your account must have at least $150.00 in order to SUBMIT the request. If not, please follow the instructions in the next paragraph to pay via check by mail.

By Check
 If you would like to pay by check, fill-out the following form and press the 'PRINT THIS PAGE' button (do not press the SUBMIT button) at the bottom of the form and send your check for $150.00 along with this form to:

Kansas Secretary of State
Attn: UCC Searches
120 SW 10th Avenue
Topeka, KS 66612

Secured Party Information

*Secured Party Name:
*Secured Party City:
   
*Requester First Name:
*Requester Last Name:
*Address 1:
Address 2:
*City:
*State:
*Zip:
*Phone:
Fax Number:
Email:
(*required if selecting
'Receive via email' below)		  

Prepaid Account Number:*

Receive via: Email (within 48 hours) U.S. Postal Service (7 - 10 days)
Notice

K.S.A. 21-3914 prohibits using names and addresses derived from public records for certain commercial purposes. This includes using public records to sell property or services. Persons are also prohibited from obtaining public records with the intention of making the records available to a third party for such purposes. Violation of this law is a criminal offense punishable as a Class C misdemeanor.

The undersigned hereby requests access to the records described above and certifies that the undersigned has a right of access to the records. The undersigned further certifies that the information obtained from the records will not be used for a prohibited purpose.

Type your name below to request a records search and to indicate that you have read and understand the conditions outlined in the above notice.

Your Name:* Date:*