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
NOTIFICATION OF NON-PROFIT ORGANIZATION
EVENT PROMOTING THE ARTS
WHO MUST COMPLETE THIS FORM?
A non-profit organization that wishes to sponsor an event promoting the arts must complete this form if non-licensed businesses wish to serve free alcoholic
liquor or Cereal Malt Beverages to members of the general public during the event. Notification must be received by the Director at least 10 days prior to
the event.
The local governing body must approve the event by ordinance or resolution, which must be submitted with this form.
Complete this form and return to the address or fax number above at least 10 days prior t
o the event.
Non-Profit Organization Information:
Organization Name
Organization Mailing Address City State Zip Code
Contact Person Name E-mail Address
Phone Number Fax Number
Event Information:
Title of Event Date(s) of Event
Beginning Time of Event Ending Time of Event
Address City State Zip Code
☐ I have attached a copy of the required ordinance or resolution authorizing this event.
☐ I have attached a list of participating businesses.
Under penalties of perjury, I declare the information contained in this document a true, accurate and complete disclosure of information.
Authorized Signature Date
ABC Office Use Only
☐Received less than 10 days prior to event.
☐Scanned to Enforcement Agent
Date: Associate:
click to sign
signature
click to edit
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