Fillable STATE OF KANSAS KANSAS DISTRIBUTORS MONTHLY REPORT OF (Kansas Department of Revenue)

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STATE OF KANSAS KANSAS DISTRIBUTORS MONTHLY REPORT OF (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
KANSAS DISTRIBUTORS’ MONTHLY REPORT OF PURCHASES - CONTINUED
Distributor Name: FEIN: Month: Year:
No.
Product
Type
Code
Vendor’s Kansas
Supplier Permit, Farm
Winery or Microbrewery
License Number
Purchase
Order
Received
Number
Purchase
Order
Received
Date
GTIN/SCC
(Optional)
UNIMERC
Selling
Units
Product
Unit Size
Unit of
Measure
Received
Quantity
Received Unit
of Measure
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.
Page of
ABC-218 (Rev. 02/18)
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signature
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STATE OF KANSAS KANSAS DISTRIBUTORS MONTHLY REPORT OF (Kansas Department of Revenue)

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Completed 24 August 2020

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