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-804 (Rev. 05/19)
SURETY BOND
FOR LIQUOR LICENSES ISSUED UNDER THE LIQUOR CONTROL ACT
Pursuant to K.S.A. 41-317
KNOW ALL MEN BY THESE PRESENTS: That we
(Principal)
of the City of , County of , State of as
Principal, and
,
(Surety)
,
a corporati
on organized and existing under and by
virtue of the laws of the State of duly licens
ed to do business in the State of Kansas, as surety are held
and firmly bound unto the Director of the Alcoholic Beverage Control Division for and on behalf of the State of Kansas in the penal sum
of
$ Dollars for the payment of which each of us, do bind ourselves, our heirs, executors, administrators,
successors and assigns, jointly and severally.
WHEREAS, the Principal has applied for or has been licensed by the Director of the Alcoholic Beverage Control Division of the State
of Kansas as a: ☐Retailer ☐Beer Distributor ☐Spirits Distributor ☐Wine Distributor ☐Farm Winery
☐Microbrewery ☐Microdistillery ☐Manufacturer ☐Non-Beverage User ☐Special Order Shipping ☐Producer
NOW, THEREFORE, if the said Principal shall faithfully comply with the provisions of the Kansas Liquor Control Act and the rules and
regulations of the Director of the Alcoholic Beverage Control Division in all respects, and shall promptly pay all fees, fines and taxes which
may be assessed, then this obligation shall be null and void, otherwise to remain in full force and effect. Such principle hereby authorizes
employees of the Kansas Department of Revenue to disclose to the surety herein a statement of account relating to the tax guaranteed
by this bond.
This bond shall be effective on and after the , ,
(Day)
, , , .
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
License Number(s): Rep’s Initials:
☐Bond Released
Date: Rep’s Initials:
FEIN: Date:
☐Bond Demand
Date: Rep’s Initials:
day of
(Month) (Year)
unless
cancellation of such bond is approved by the Director of the Alcoholic Beverage Control Division, Department of Revenue, after having
been given thirty (30) day notice by the principal and surety.
Witness our hands at
(City) (State)
this
(Day)
day of
(Month) (Year)
SURETY COMPANY (please print)
Signature of Attorney-in-Fact* for Surety Company:
Attorney-in-Fact Name:
Attorney-in-Fact Phone Number:
Surety Company Name:
Surety Company Mailing Address:
Surety Company Phone Number:
BOND NUMBER:
PRINCIPAL (please print)
Signature of Principal or Agent:
Title:
Print Name of Signature Above:
Mailing Address:
Phone Number:
Check Entity Type:
Individual Corporation Partnership LLC LLP Trust Government Other
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