Fillable REQUEST FOR TEMPORARY EXTENSION OF PREMISE (ABC-816) Alcoholic (Kansas Department of Revenue)

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REQUEST FOR TEMPORARY EXTENSION OF PREMISE (ABC-816) Alcoholic (Kansas Department of Revenue)

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ABC-816 (Rev. 07/19)
Page 1 of 3
Alcoholic Beverage Control
109 SW 9th Street, 5th Floor
PO Box 3506
Topeka KS 66601-3506
Phone: 785-296-7015
Fax: 785-296-7185
Kdor_abc.email@ks.gov
www.ksrevenue.org/abcindex.html
REQUEST FOR TEMPORARY EXTENSION OF PREMISE (ABC-816)
WHICH FORM DO I NEED TO COMPLETE?
Complete and submit this REQUEST FOR TEMPORARY PREMISE APPROVAL (ABC-816) if you:
currently poss
ess a liquor license and are applying for a temporary extension of your licensed premise. If you do
not have control of the area you are extending into, you must provide written permission from the owner or
the city/county.
If you are extending into public streets, alleys, roads, sidewalks or highways, you must provide a copy of the ordinance or
resolution approval issued by the local governing body.
Complete and submit the REQUEST FOR PERMANENT PREMISE APPROVAL (ABC-806) if you:
are applying for a new li
quor license.
currently posses
s a liquor license and are applying for a permanent change to your existing licensed premise.
currently possess a liquor license and are changing your location. You must also complete and submit the
ABC LIQUOR LICENSE/PERMIT BUSINESS NAME AND/OR ADDRESS CHANGE FORM (ABC-22) along with a
copy of your lease or deed.
All forms may be f
ound on our website at: https://ksrevenue.org/abcforms.html
INSTRUCTIONS FOR THIS TEMPORARY EXTENSION OF PREMISE REQUEST (ABC-816):
1. LICENSEE INFORMATION. Enter the licensee information requested.
2. TEMPORARY EXTENSION INFORMATION. Check the appropriate box(es).
a.
If licensee does not have control of the premises, attach written permission from the property owner or city/county to this
form before submission.
b. If licensee is to extend onto a public street, alley, road, sidewalk or highway, attach the approved ordinance/
resolution to this form before submission.
3. DIAGRAM. Check
the appropriate box, then draw a complete diagram of the premises for which you are seeking
license approval or attach your own drawing, provided it is no larger than 8½ X 11, to this form.
a. The diagram must
include all entrances, exits and interior doors, walls, coolers, bars, liquor storage space,
kitchen, counters, sales area, office, restrooms, premises boundaries, etc.
b. The diagram must show approximate dimensions of the premise for which you are seeking approval.
c. The diagram must indicate your current premise (if applicable) as well as the temporary extension area.
4. ZONING. Tak
e the form to the city/county clerk to complete the zoning section of the form.
5. Sign and date form.
6. Submit your completed request to the ABC by mail, fax or email to KDOR_ABC.Licensing@ks.gov at least 10
calendar days prior to the temporary extension event date.
CONTACT INFORMATION:
If you have questions or need assistance, please contact us by:
Phone: 785-296-7015; or, Email:
KDOR_ABC.Email@ks.gov
Fax: 785-296-7185
Kdor_abc.email@ks.gov
www.ksrevenue.org/abc.html
Alcoholic Beverage Control
Phone: 785-296-7015
109 SW 9th Street, 5th Floor
PO Box 3506
Topeka KS 66601-3506
Licensee Information
Business DBA Name License Number
Business Location Street Address City Zip Code
Contact
Phone Person Phone Number Email Address
Event
Date(s) Event
Start
Time(s)
Event
End
Time(s)
I have attached the ordinance or resolution approved by the local governing body.
☐Yes ☐No
I am extending onto unlicensed or unpermtted premises
Is the area of the extension under the
control of the licensee?
☐Yes
☐No
I have attached written permission from the owner or city/county.
☐Yes
☐No
I am extending onto a temporarily permitted premises.
What is the event name?
I am extending onto any of the following areas: public streets, alleys, roads, sidewalks or highways.
Check one: ☐Diagram drawn below
☐ 8½” X 11” drawing attached
on supplimental page
Diagram: Draw a complete diagram of the premises for which you are seeking approval or attach your drawing. The
diagram
must indicate the current premise and the temporary extension area. Architectural drawings will not be accepted.
ABC-816 (Rev. 07/19)
Page 2 of 3
REQUEST FOR TEMPORARY EXTENSION OF PREMISE APPROVAL
Temporary Extension Information
Check all that apply:
Alcoholic Beverage Control
Phone: 785-296-7015
Fax: 785-296-7185
109 SW 9th Street, 5th Floor
Kdor_abc.email@ks.gov
PO Box 3506
www.ksrevenue.org/abc.html
Topeka KS 66601-3506
ABC Office Use Only
☐ DIAGRAM APPROVED AS SUBMITTED
Signature of ABC Official Date
☐ DIAGRAM DENIED
Reason Denied:
Zoning:
C
ERTIFICATE OF CITY, TOWNSHIP OR COUNTY CLERK
I HEREBY CERTIFY T HAT THE PREMISES AT IS:
Location Street Address City Zip
(Check one box in each section below)
CITY LIMITS: ☐ Inside the incorporated city limits ☐ Outside the city limits
County
(Seal)
CLERK SIGNATURE ☐ City Clerk ☐ Township Clerk ☐ County Clerk
PRINTED NAME
DATE PHONE
☐ I understand that I must maintain a copy of the approved diagram on the licensed premise and it must be available for
immediate inspection upon request.
Under penalties of perjury, I declare the information contained in this document a true, accurate and complete disclosure of information.
Licensee Signature Printed Name Date
ABC-816 (Rev. 07/19)
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REQUEST FOR TEMPORARY EXTENSION OF PREMISE (ABC-816) Alcoholic (Kansas Department of Revenue)

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Completed 24 August 2020

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