Fillable STATE OF KANSAS KEG TAG ORDER FORM D (Kansas Department of Revenue)

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STATE OF KANSAS KEG TAG ORDER FORM D (Kansas Department of Revenue)

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The STATE OF KANSAS KEG TAG ORDER FORM D (Kansas Department of Revenue) form is 1 page long and contains:

  • 1 signature
  • 5 check-boxes
  • 13 other fields

Country of origin: US
File type: PDF

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ALCOHOLIC BEVERAGE CONTROL
109 SW 9
th
STREET
P
.O. BOX 3506
TOPEKA KS 66601-3506
☐ ☐ ☐ ☐ ☐
STATE OF KANSAS
D
EPARTMENT OF REVENUE
P
HONE: 785-296-7015
F
AX: 785-296-7185
www.ksrevenue.org/abc.html
KEG TAG ORDER FORM
Please complete and return this form to order keg tags.
Check one: Retail Liquor Store Microbrewery CMB Retailer Military Retailer Farm Winery
Retailer Information:
Owner Name:
DBA Name:
License Number / CMB Stamp Number / ATF Number:
Address:
City / State / Zip:
Phone: Fax:
Mailing Information:
(if different from retailer address)
Name:
Address:
City / State / Zip:
Order Information:
Quantity of Tags Requested:
Name of Person Requesting Tags:
Signature of Person Requesting Keg Tags Date
ABC Office Use Only:
Keg Tag Numbers Issued: Starting #: Ending #:
Quantity Issued:
Date Issued:
Issued By:
ABC-171 (Rev. 02/18)
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STATE OF KANSAS KEG TAG ORDER FORM D (Kansas Department of Revenue)

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Completed 24 August 2020

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