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
Kdor_abc.email@ks.gov
www.ksrevenue.org
Laura Kelly, Governor
ABC-41 (Rev. 02/18)
ABC Open Records Request
FEIN/License #:
Contact Phone #:
Name Phone Number Email Address
Address
Other:
$5.25 X =
Total: $
I. Taxpayer/Licensee Information:
Name of Business:
Name of Owner:
Business Location:
City, State and Zip Code:
II. Contact
Information:
City, State and Zip Code
III. Record(s) being requested: (There is as fee for each item requested, if fee is not listed see page 2 of this form.)
(Year) (Year) (Year) (Fee)
Liquor License Application $5.25
License Bond $5.25
DateSignature
Name of Your BusinessPrinted Name and Title
I request the Director of Alcoholic Beverage Control and/or the Director of Taxation furnish me with a copy of items
checked above. Under the penalties of perjury, I declare that the information I have furnished above, to the best of
my knowledge, is true, correct and complete. I further declare that I am the taxpayer/licensee, or the officer for the
taxpayer/licensee and have authorization to receive information.
IV. Signature Before signing this document, read this section carefully.
Mark A. Burghart, Secretary
click to sign
signature
click to edit
Instructions:
1. Complete this form, including signature and date. Provide a completed form for each request. (You may make
copies of this form.)
2. The department will provide records upon a direct match. If you have not provided enough information to
establish a direct match, the department will contact you requesting additional information.
3. Mail the request form to: KDOR Records Request, Office of Research & Analysis
109 SW 9
th
Street
PO Box 3506
Topeka, KS 66601-3506
4. If the fee is not listed, the department will notify you of the fee(s) due. However, a typical request, consisting
of a copy of a license and owner information, results in a fee of $5.25. All fees should be paid by check or
money order. Make the check or money order payable to the “Kansas Department of Revenue”. Payment is
required prior to the release of the requested records. No refunds will be issued for requests made in error, or
requests for records not on file.
Fees:
The Kansas Department of Revenue has several fees that are fixed by the Secretary of Revenue, pursuant to K.S.A.
74-2022. Some of the fixed record fees include but are not limited to: Driver’s License or Vehicle Title and
Registration records, copies of tax returns, records maintained within the Kansas computer assisted mass appraisal
system (KS CAMA), and Automobile Dealer Licensing records. The appropriate request forms, for the above-
mentioned record types, are available at www.ksrevenue.org.
The following fee structure applies only to those records that do not have fixed fees (see above):
Copies (per page) $0.25
Mail charge (first 5 pages) $0.40
(additional 5-page increments) $0.25
Faxed copy $0.65
Search charge (staff time per hour) $25.00
Computer time (staff time per hour) $60.00
Copy & Search Charge Fees: The 25-cent copy charge is a per page charge which is principally assessed to reimburse
the agency for routine costs of retrieving records which are requested with specificity and are held within the agency's
current file system. It does not include the cost of more than one-tenth of an hour of research or access time required
to determine the location of records not readily accessible, to determine what specific records meet request criteria, to
segregate public from non-public information, to access records from archives and other similar necessary services.
For such services in providing access or copies, the $25 per hour search charge may be assessed, to be billed by the
tenth of an hour.
Mail Charge Fee: The mail charge may be assessed in addition to the copy charge when mail service is requested.
For up to and including the first five pages, 40 cents may be charged, plus an additional 25 cents for up to and including
each additional five pages. If air express delivery is requested, you must provide a prepaid envelope or an account
number for such delivery.
Fax Fee: The Fax charge of 65 cents per page includes those services required in copying a record, in addition to
domestic fax transmission costs. No additional copy charge is assessed.
Computer Time Fee: The computer time charge of $60 per hour, also billed in tenths, is for staff time, including
associated computer connect and processing time, for providing copies of records in available electronic format or for
production of special computer-generated reports. The Official Custodian will be the sole judge of the ability of the
agency to comply with any request for records in specific electronic format or the ability to produce any special
computer-generated reports.
The agency will provide an estimate of fees to be charged prior to providing records, and where such estimate is
provided, fees actually charged shall not exceed such estimate. The agency reserves the right to require any estimated
charge for access to or copies of records be received before work is performed to produce the records in order to insure
payment.
ABC-41 (Rev. 02/18)