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Commercial Industrial Hemp Processor Application (Submit Online)

2. Application Type

   1. New
   2. Renewal

4. COMPLETE ALL 9 SECTIONS, REFER TO K.A.R. 22-26-2 FOR GUIDELINES

6. Section 1 Legal Name
   For background purposes, use full legal name. This name will also be printed on applicant’s permit.

   For background purposes, use full legal name. This name will also be printed on applicant’s permit.

8. Last Name

9. First Name

10. MI

12. Section 2 Applicant's Current Permit Number (if renewal)

14. Permit Number

16. Section 3 Personal Information

18. DOB
    DOB

19. Age

    In years

20. Gender

    1. Male
    2. Female

22. Last 4 digits of Social Security Number

23. Drivers License Number

24. State

26. U.S. Citizen

    1. Yes
    2. No

27. If not a U.S. citizen, please provide Alien Registration Number

29. Have you been convicted of a felony?

    1. Yes
    2. No

31. Section 4 Contact Information

33. Home Phone Number

34. Mobile Number

35. Email Address

37. Section 5 Business Information

39. Business Name

41. Address

43. City

44. State

45. Zip Code

47. Latitude and Longitude of Location

49. Section 6 Physical & Mailing Address
    Physical address of any buildings that are owned/leased by the company and used in any part of the processing operation.

    Physical address of any buildings that are owned/leased by the company and used in any part of the processing operation.

51. Physical

53. Address

55. City

56. County

57. State

58. Zip Code

60. Mailing
    For official correspondence with our office.

    For official correspondence with our office.

62. Address

64. City

65. County

66. State

67. Zip Code

69. Section 7 Officers, Proprietors, Partners of Entity, and Employees
    Each owner of more than a 10% interest in the processing operations, as well as employees.

    Each owner of more than a 10% interest in the processing operations, as well as employees.

71. Last Name

72. First Name

73. MI

75. DOB
    DOB

76. Age

    In years

77. Gender

    1. Male
    2. Female

79. Last 4 Digits of Social Security Number

80. Driver's License Number

81. State

83. U.S. Citizen

    1. Yes
    2. No

84. If not a U.S. citizen, please provide Alien Registration Number

86. Have you been convicted of a felony?

    1. Yes
    2. No

88. Last Name

89. First Name

90. MI

92. DOB
    DOB

93. Age

    In years

94. Gender

    1. Male
    2. Female

96. Last 4 Digits of Social Security Number

97. Driver's License Number

98. State

100. U.S. Citizen

     1. Yes
     2. No

101. If not a U.S. citizen, please provide Alien Registration Number

103. Have you been convicted of a felony?

     1. Yes
     2. No

105. Last Name

106. First Name

107. MI

109. DOB
     DOB

110. Age

     In years

111. Gender

     1. Male
     2. Female

113. Last 4 digits of Social Security Number

114. Driver's License Number

115. State

117. U.S. Citizen

     1. Yes
     2. No

118. If not a U.S. citizen, please provide Alien Registration Number

120. Have you been convicted of a felony?

     1. Yes
     2. No

122. If more space is needed for individuals, upload their complete information as supporting documentation below.

124. Section 8 A brief description of the industrial hemp processing methods that will be used, activities that will be undertaken, and finished products planned for production.

126. Section 9 Applicants Signature

128. Under the penalties imposed by K.S.A. 21-3805, I declare that I have examined this application and any documents submitted in support thereof, and to the best of my knowledge and belief, they are true, correct and complete. I also certify that I am familiar with all published state laws and local ordinances relating to hemp processing for the location(s) in which I intend to do business.

     Under the penalties imposed by K.S.A. 21-3805, I declare that I have examined this application and any documents submitted in support thereof, and to the best of my knowledge and belief, they are true, correct and complete. I also certify that I am familiar with all published state laws and local ordinances relating to hemp processing for the location(s) in which I intend to do business.

130. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
132. Electronic Signature

134. Please upload supporting documents

     Only PDFs are accepted

136. Supporting Documentation
     Additional officers, proprietors, partners of entity and/or employees.

     Additional officers, proprietors, partners of entity and/or employees.

138. Policies and Procedures Manual

     Policies and Procedures Manual

140. Fingerprint cards, signed Consent to Search forms and criminal background checks for applicant, additional officers, proprietors, partners of entity and/or employees

     Fingerprint cards, signed Consent to Search forms and criminal background checks for applicant, additional officers, proprietors, partners of entity and/or employees

142. Code Footprints

     Code Footprints

144. Supporting documentation can be provided after application is submitted if necessary.
     Supporting documents can be submitted to ksfm_hemp@ks.gov after application is filed.

     Supporting documents can be submitted to ksfm_hemp@ks.gov after application is filed.

146. Once your application is approved, you will be notified of any fees that are due.

Leave This Blank:


148. 1. Receive an email copy of this form.
149. Email address

     This field is not part of the form submission.

150. Submit

* indicates a required field