Fillable STATE OF KANSAS INSTRUCTIONS REPORT OF ALCOHOLIC LIQUOR (Kansas Department of Revenue)

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STATE OF KANSAS INSTRUCTIONS REPORT OF ALCOHOLIC LIQUOR (Kansas Department of Revenue)

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  • 1 check-box
  • 73 other fields

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A
LCOHOLIC BEVERAGE CONTROL
109 SW 9
th
STREET
P.O. B
OX 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
REPORT OF ALCOHOLIC LIQUOR RECEIVED FROM KANSAS MANUFACTURER
INSTRUCTIONS
WHO MUST COMPLETE THIS FORM?
This form must be completed by any person or firm not located in the State of Kansas who receives alcoholic liquor from
a licensed Kansas manufacturer.
WHEN IS THE FORM DUE?
The completed form is due by the 15
th
of the month following receipt of alcoholic liquor from a Kansas manufacturer.
INSTRUCTIONS TO COMPLETE THE REPORT OF ALCOHOLIC LIQUOR RECEIVED FROM KANSAS
MANUFACTURER:
1. PURCHASER INFORMATION. Compete the requested information.
2. Enter the report period month and report year.
3. SPREADSHEET ATTACHED. Check this box only if you elect to attach a spreadsheet to the form. The spreadsheet
must contain identical column headings to the form.
4. ALCOHOLIC LIQUOR RECEIVED FROM A KANSAS MANUFACTURER. Complete the information requested:
a. SHIPMENT DATE. Enter the date shipped from your invoice.
b. PURCHASE ORDER NUMBER. Enter the purchase order number from your invoice.
c. NUMBER OF GALLONS. Enter the number of wine gallons that you received from the Kansas manufacturer.
DO NOT report proof gallons.
d. KANSAS MANUFACTURER’S LICENSE NUMBER. Enter the license number for the manufacturer you are
purchasing alcoholic liquor from. You may obtain the license number from our Active Liquor Licensee database
on our website at: https://www.kdor.ks.gov/apps/LiquorLicensee/LiquorLicenseeSearch.aspx
e. KANSAS MANUFACTURER’S DBA NAME. Enter the name of the Kansas manufacturer from whom you are
purchasing from.
5. Sign the form. Enter your title and the date you signed the form.
6. Retain a copy for your records.
7. Submit the completed original form to the address on the form by the due date.
CONTACT INFORMATION:
Questions may be directed to the ABC Marketing Unit.
Phone: 785-296-7015
Email: KDOR_ABC.Marketing.Unit@ks.gov
ABC-274 (Rev. 02/18)
STATE OF KANSAS
A
LCOHOLIC BEVERAGE CONTROL
109 SW 9
th
STREET
P.O. B
OX 3506
T
OPEKA KS 66601-3506
D
EPARTMENT OF REVENUE
P
HONE: 785-296-7015
F
AX: 785-296-7185
www.ksrevenue.org/abc.html
REPORT OF ALCOHOLIC LIQUOR RECEIVED FROM KANSAS MANUFACTURER
PURCHASER INFORMATION
Purchaser DBA Name
Business Mailing Address
City
State
Zip Code
Person Completing Report
E-Mail Address
Telephone Number
Fax Number
Report Period Month: Year:
☐ Spreadsheet attached
ALCOHOLIC LIQUOR RECEIVED FROM KANSAS MANUFACTURER
SHIPMENT
DATE
PURCHASE
ORDER NUMBER
NUMBER OF
GALLONS
KANSAS MANUFACTURER’S
LICENSE NUMBER
KANSAS MANUFACTURER’S DBA
NAME
This report must be filed by the 15
th
day of the following month.
All records shall be maintained for three years and shall be available for inspection by the Director or any agent or employee
of the Director or Secretary upon request. DO NOT SEND INVOICES.
I declare under penalties of perjury that to the best of my knowledge and belief this is a true, correct and complete return.
SIGNATURE TITLE
State whether individual owner, member of firm, or title if officer of corporation.
DATE
ABC-274 (Rev. 02/18)
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STATE OF KANSAS INSTRUCTIONS REPORT OF ALCOHOLIC LIQUOR (Kansas Department of Revenue)

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Completed 24 August 2020

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