APPLICATION FOR SPECIAL EVENT TAX CLEARANCE
KANSAS DEPARTMENT OF REVENUE
1. Name and date of event for which you are requesting a clearance letter.
Event Name: Event Date:
2. Applicant Information: Business Individual (Please check one)
Name (Registered) Identification Number (FEIN or SSN)
Business Name (If different than registered name) Tax Identification Number (if applicable)
Current Street Address City, State, ZIP
Daytime Telephone Number Fax Number
Cell Phone Number Email Address
3. Previous events at which you vended in Kansas in the last three years
No Kansas sales tax account? List the event(s) name and date(s) below: (Use back if more space is needed)
4. Event copy (choose one box only)
Submit a copy of my tax clearance letter to the event noted above
Do not submit my tax clearance letter to the event noted above
5. Signature
Print Name Title (Corporate Officer, Partner, Individual, etc)
Signature Date
6. Send this request to the Kansas Department of Revenue Special Events
Mail: Kansas Department of Revenue
Attn: Special Events
7600 W 119 St., Suite A
Overland Park, KS 66213-1106
Fax: 866-743-4812
Email: kdor_special.events@ks.gov
If you need any additional copies of this form you can find it at: https://www.ksrevenue.org/specialsalesevents.html
or have any questions, please contact Special Events at 785-207-1572.
CM-21 (Rev. 4-18)
