Get Change Of Name/ownership Form - Kansas.gov - Kansas

The Change Of Name/Ownership Form is required for updating the name or ownership details of a facility in Kansas. This guide provides clear instructions on how to accurately fill out the form online, ensuring that all necessary information is provided for a seamless filing process.

Follow the steps to successfully complete the Change Of Name/Ownership Form.

1. Press the ‘Get Form’ button to acquire the form and open it in your editor.
2. Indicate the new facility name in the designated field, ensuring it is accurate and reflects the desired change.
3. Enter the old facility name in the appropriate section to provide context for the change being requested.
4. Fill in the facility address, making sure to include all relevant details to avoid any confusion regarding location.
5. Provide the current email address associated with the facility and/or owner to ensure proper communication.
6. Enter the facility license number—this is critical for reference in the processing of your request.
7. Include the current phone number for the facility and/or owner for any follow-up inquiries.
8. List the names of the current owners, ensuring all are accurately recorded, as at least one original owner must remain on the license.
9. For ownership change, specify the facility name and address again to clarify what is being changed.
10. Document the old ownership and the new ownership in their respective sections, ensuring clarity and accuracy in the details provided.
11. Complete the attestation section by signing and dating the form to confirm the information is true and correct, with all owners listed signing as required.

Complete your Change Of Name/Ownership Form online to ensure your facility's information is up-to-date.