Office of the Secretary of State/ Elections Division
State of Kansas Flag Order Form
FS/FW
64 / 77
Name
Send to:
Kansas Secretary of State, Kris W. Kobach
Memorial Hall, 1st Floor w 120 S.W. 10th Avenue
Topeka, KS 66612-1594
Phone: (785) 296-4557 w Fax: 785-291-3051
www.sos.ks.gov
Address
City / State / Zip
Telephone
Credit Card Number
Type: Visa
MC
Discover
Exp.
CVV code _____(last 3 digits on back of card)
Flags
Price
DO NOT WRITE IN THIS SPACE
Quantity
Total
Fund
4’ X 6’ nylon
$40.00
3’ X 5’ nylon
$30.00
03
8” X 12” rayon w/stick
$6.00
06
4” X 6” rayon w/stick
$2.50
07
Flag stands (for 4” X 6” flag)
$.50
08
«« Certificate for flying flag
$5.00
01
60-32
Shipping
+ 5.00
Subtotal
*Tax
www.ksrevenue.org
60-26
95-01
Total
* Sales tax must be paid by all Kansas residents unless specifically exempted (To compute
correct tax, go to www.ksrevenue.org and select “Kansas Sales and Use Tax Locator”
under “Your Business,” then look up the tax rate by using your mailing address below.)
«« To fly flags over the Capitol, please provide the following information:
Date flag should be flown:
Person(s)/organization requesting to fly the flag:
Person(s)/organization for whom the flag is being flown:
Special occasion (if applicable):
Rev. 1/10/11 jdr
Notice: There is a $25 service fee for all returned checks.
K.S.A. 75-419