Form Cm-20 - Application For Tax Clearance
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1Kathleen Sebelius, Governor
Joan Wagnon, Secretary
________________________________________________________________
APPLICATION FOR TAX CLEARANCE
1. Applicant Information
Business
Individual (Please check one)
FEIN
SSN (Please check one)
Name (Registered)
Identification Number (FEIN or SSN)
Business Name (If different than registered name)
Tax Identification Number
____________________________________
Current Street Address
City, State, Zip
Telephone Number
FAX Number
2. Tax Account Information
Check the appropriate tax types you or the business is registered to remit to the State of Kansas.
Individual Income
Retailers’ Sales
Retailers’ Comp Use
Consumers’ Comp Use
Franchise
Withholding
Non-resident withholding
Other ________________________
Corporate Income ____________________________________________________________________
Parent Corporation Name (If Corp Income is filed under Parent Corporation)
Reason for Tax Clearance request
Type of business (If applicable)
Do you or the business make retail sales in Kansas?
YES
NO
NA
Do you or the business have an office or retail outlet in Kansas?
YES
NO
NA
Do you or the business have employees in Kansas?
YES
NO
NA
Do you or the business purchase out of state merchandise for use or
sale in Kansas?
YES
NO
NA
Do you or the business have Kansas source income?
YES
NO
NA
3. Signature
_________________________________________
_______________________________________
Print Name
Title (Corporate Officer, Partner, Individual, etc)
_________________________________________
_______________________________________
Signature
Date
COMPLIANCE ENFORCEMENT – BUSINESS INTELLIGENCE TEAM
DOCKING STATE OFFICE BUILDING, 915 SW HARRISON ST., TOPEKA, KS 66625-2001
Voice 785-296-3199
Fax 785-296-3655
CM-20
(REV. 04/20/07)
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Parent category: Financial