Get Licensee Offense Report Form - Kansas.gov

Filling out the Licensee Offense Report Form is an important step for reporting any legal issues affecting a licensed individual in Kansas. This guide will walk you through the process of accurately completing the form online to ensure compliance with reporting requirements.

Follow the steps to fill out the Licensee Offense Report Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your personal reporting information in the designated fields. Fill in your name, license number, address, city, state, phone number, email, and ZIP code accurately.
3. Next, provide the information for the licensee or company being reported. Enter their name and license/company number in the appropriate sections.
4. Indicate your relationship to the reported offense by checking the appropriate box: whether you are a licensee or a supervising/branch broker reporting an offense.
5. Provide details about the criminal charges, including the name of the arresting agency or court and the city and state of the agency or court.
6. Report the status of the charges by checking all relevant options, such as if the individual was arrested, pledged guilty or no contest, charged or indicted, or received a diversion.
7. Enter the date of the arrest or when charges were filed. Additionally, include the citation or case number and the date of plea or conviction.
8. List the offenses in the designated field and provide a detailed explanation of the events surrounding the offense. If necessary, attach additional pages to provide more context.
9. Complete the certification section by declaring the truthfulness of the information provided. Remember that no electronic or stamped signatures are permitted.
10. Finally, sign and date the form to complete the submission process. Once finished, you may save changes, download, print, or share the completed form as needed.

Complete your documents online today to ensure timely and accurate reporting.