Fillable STATE OF KANSAS CEREAL MALT BEVERAGE (CMB) STAMP (Kansas Department of Revenue)

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STATE OF KANSAS CEREAL MALT BEVERAGE (CMB) STAMP (Kansas Department of Revenue)

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A
LCOHOLIC BEVERAGE CONTROL
109 SW 9
th
STREET
P.O. BOX 3506
T
OPEKA KS 66601-3506
STATE OF KANSAS
DEPARTMENT OF REVENUE
P
HONE: 785-296-7015
F
AX: 785-296-7185
www.ksrevenue.org/abc.html
CEREAL MALT BEVERAGE (CMB) STAMP ORDER FORM
To order State CMB Stamps, please complete and return this form via mail, fax or e-mail.
City/County Clerk Information:
City / County Name:
City / County ID Number:
Name of Person Requesting CMB Stamps:
Title of Person Requesting CMB Stamps:
Mailing Address:
City / State / Zip:
Phone: Fax:
CMB Order Information
*Quantity of State CMB Stamps Requested:
*Order CMB Stamps in multiples of five (5) up to a maximum of 500.
Signature of Person Requesting State CMB Stamps Dat
e
ABC Office Use Only:
CMB Stamp Numbers Issued: Starting # Ending #:
Quantity Issued:
Date Issued:
Issued By:
ABC-303 (Rev. 02/18)
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STATE OF KANSAS CEREAL MALT BEVERAGE (CMB) STAMP (Kansas Department of Revenue)

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Completed 24 August 2020

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