Seal of the Kansas Insurance DepartmentKansas Insurance Department
420 SW 9th Street
Topeka, KS 66612-1678

REQUEST FOR ACCESS TO PUBLIC RECORDS

K.S.A. 45-230 states, in pertinent parts, as follows:
"(a) No person shall knowingly sell, give or receive, for the purpose of selling or offering for sale any property or service to persons listed therein, any list of names and addresses contained in or derived from public records except: [see above link for exceptions]. (b) Any person subject to this section who knowingly violates the provisions of this section shall be liable for the payment of a civil penalty in an action brought by the attorney general or county or district attorney in a sum set by the court not to exceed $500 for each violation."

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Your Information
* First Name:
MI:
* Last Name:
Company or Firm Name (optional):
* Street:
* City:
* State:
* Zip:
* E-mail:
Phone number where you can be reached during business hours:
Your Request
* Description of Records Requested:
(Please be as specific as possible. Do not use quotation marks, apostrophes, or other special characters.)
What is the time frame?
(e.g. current; last two years; January 1, 2002 to present; etc.)
Any additional detail that will aid in quickly locating the documents you are requesting:
 
* I authorize the Kansas Insurance Department to incur costs up to $ to process this request.
You will be contacted with an actual estimate before work is done if the cost is higher than authorized.

Pursuant to K.S.A. 45-218 and 45-219 actual agency costs incurred in responding to your request will be assessed. Actual agency costs include any personnel time involved as well as any document copies provided to you. For information on costs, see the Kansas Insurance Department Open Records Act brochure.