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
NOTICE OF INTENT TO SELL
Name of Corporation, Individual, Partnership, LLC
DBA Name Kansas Liquor License Number
Location Address
City State Zip Code
Phone Number E-mail Address
Transaction Type: (check one)
☐ Selling Business
☐ Change Entity
I/We,
(MANAGING OFFICER OF CORPORATION OR LLC, OR ALL MEMBERS OF PARTNERSHIP, OR SOLE OWNER)
intend to sell the above listed business on or about
(PROPOSED DATE OF SALE OR CHANGE)
to .
(BUYER)
☐ I authorize ABC to inactivate my license. I understand that I must complete the back of the license, sign (owner or officer signature)
and return my license to the ABC. (Does not apply if the business is sold 100% intact.)
☐ I understand that all taxes must be paid, including any penalty and interest owed. If liquor taxes are not paid, they will be deducted from
my bond.
☐ I understand that all liquor fines must be paid. If liquor fines are not paid, they will be deducted from my bond.
☐ I understand my bond will be released upon completion of the above. If I have a cash bond, I must provide the original receipt.
I/We hereby affirm that I/we will remain in active ownership and management control of the above named business and will remain
responsible for the licensed premise until a license is issued to the buyer or buyers of the business by the Alcoholic Beverage Control.
I declare under penalties of perjury that to the best of my knowledge and belief this is a true, correct and complete statement.
SIGNATURE
(MANAGING OFFICER, OWNER, PARTNER, SOLE OWNER)
*TITLE
*T
itle – state whether individual owner, member of firm, or title if officer or corporation.
DATE
SIGNATURE
(MANAGING OFFICER, OWNER, PARTNER, SOLE OWNER)
*TITLE DATE
SIGNATURE
(MANAGING OFFICER, OWNER, PARTNER, SOLE OWNER)
*TITLE DATE
SIGNATURE
(MANAGING OFFICER, OWNER, PARTNER, SOLE OWNER)
*TITLE DATE
ABC-811 (Rev. 07/18)
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