Fillable Alcoholic Beverage Control Street, 5 Floor 109 SW (Kansas Department of Revenue)

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Alcoholic Beverage Control Street, 5 Floor 109 SW (Kansas Department of Revenue)

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CLOSING YOUR BUSINESS
PRINTED
NAME:
☐
Other:
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/abcindex.html
If you are closing your business, you must complete this form.
LICENSE
NUMBER:
FEIN:
PHONE:
DATE:
DBA NAME:
CLOSURE
DATE:
MAILING
ADDRESS:
EMAIL
ADDRESS:
☐ I am requesting a refund, iff applicable, for the unused portion of my liquor license.
REASON FOR CLOSURE:
☐
CMB licensees allowed to sell beer containing not more than 6% alcohol by volume
TITLE:
OWNER/AGENT
SIGNATURE
:
RETURN THIS COMPLETED FORM TO:
Email: KDOR_ABC.Licensing@ks.gov
OR
Fax: 785-296-7185
ABC-824 (Rev. 12/20)
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Alcoholic Beverage Control Street, 5 Floor 109 SW (Kansas Department of Revenue)

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Completed 8 February 2021

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