Alcoholic Beverage Control
109 SW 9
th
Street, 5
th
Floor
PO Box 3506
Topeka KS 66601-3506
Phone: 785-296-7015
Fax: 785-296-7185
www.ksrevenue.org/abc.html
ABC LIQUOR LICENSE/PERMIT BUSINESS NAME AND/OR ADDRESS CHANGE FORM
Business Name License Number
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I am changing my Business Name to:
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I am changing my DBA Name to:
I am changing my: Business Mailing Address Business Location Address
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NEW BUSINESS MAILING ADDRESS
Street County City State Zip
Phone Number Email Address
BUSINESS LOCATION ADDRESS
ABC-806 Premise Approval attached
Lease/Deed attached
Current Location Address Street County City State Zip
New Location Address Street County City State Zip
Phone Number Email Address
Effective Date
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Ins
ide City Limits
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Outside City Limits
This change will affect the following license/permit type(s):
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Retailer
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Beer Distributor
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Packaging and Warehousing Facility
☐ Class A Club ☐ Spirits Distributor ☐ Beer Manufacturer
☐ Class B Club ☐ Wine Distributor ☐ Spirits Manufacturer
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Drinking Establishment
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Supplier Permit
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Wine Manufacturer
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Hotel / Drinking Establishment
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Microbrewery
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Farm Winery
☐ Caterer ☐ Microbrewery Packaging and
Warehousing Facility
☐ Farm Winery Outlet
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Drinking Establishment / Caterer
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Farm Winery / Caterer
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Hotel / Caterer
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Non-Beverage User
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Special Order Shipping
☐ Public Venue ☐ Microdistillery ☐ Microdistillery Packaging and
Warehousing Facility
☐ Producer ☐ Common Consumption Area
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Other
Signature Date
Return your completed form to the above address.
ABC Office Use Only
Signature of ABC Licensing Customer Rep Date
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Signature of ABC Licensing Customer Rep
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Signature of ABC Director
ABC-22 (Rev. 05/19)
click to sign
signature
click to edit
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