ALCOHOLIC BEVERAGE CONTROL
109 SW 9
th
STREET
P.O. BOX 3506
TOPEKA 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 INDUSTRY SEMINAR
Submit your completed form to the address or fax number above at least (7) days prior to the event.
Distributor Information:
Distributor Name License Number(s)
Phone Number Contact Person Name
Seminar Information:
This seminar is for the following licensees and their employees (check all that apply):
Retailers Clubs Drinking Establishments Caterers Hotel Drinking Establishments
Date:
From T
ime:
To Time:
Location Address:
Additional Information:
Pursuant to K.S.A 41-709 and K.A.R. 14-14-6(a), by submitting this notice we acknowledge that:
1. liquor enforcement taxes, based on the current posted prices of the products, must be remitted on any
alcoholic beverages removed from our inventory for this seminar,
2. the seminar is conducted solely for product information and marketing purposes,
3. any alcoholic beverage samples will be consumed only on the seminar premises and in accordance with
Kansas law; and,
4. the alcoholic liquor and/or cereal malt beverage samples provided at this seminar are for licensees and
their employees.
Under penalties of perjury, I declare the information contained in this document a true, accurate and
complete disclosure of information.
Authorized Signature Date
Printed Name Printed Title
ABC Office Use Only
N
otified Licensee via: ☐Email ☐Fax ☐Mail
Notified Enforcement via email: ☐Yes
Signature of ABC Official Date
ABC-190
(Rev. 02/18)
click to sign
signature
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