A
LCOHOLIC BEVERAGE CONTROL
109 SW 9
th
STREET
P.O. BOX 3506
T
OPEKA 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
REQUEST TO EXTEND LICENSE TERM
Effective July 1, 2010, the Director may, at the Director’s sole discretion and after examination of the circumstances, extend the license term of any license for not more
than 30 days beyond the date such license would expire. ¹
¹A request for extension does not constitute the ability to operate without a liquor license. Determination of your request will be made and you will be notified of the decision within
5 calendar days from the receipt of your request. In the event your request is approved, you will be provided with a license extension. If you request is denied, you must cease the
sale of alcoholic liquor immediately upon expiration of your liquor license.
Any extension of the license term by the Director shall automatically extend the due date for payment by the licensee of any occupation or license tax levied by a city or
township by the same number of days the Director has extended the license term.
Licensee Information:
Licensee Name License Number
Address City State Zip Code
Phone Number Fax Number
E-mail Address
Circumstance of Request:
☐ Death
☐ Fire
☐ Natural disaster (flood, tornado, etc.)
☐ Serious illness or injury resulting in hospitalization
☐ Other – Explain:
☐ I have attached the documentation supporting my request for a license term extension. ²
²Documentation supporting the circumstances of your request must be attached to this form.
Under penalties of perjury, I declare the information contained in this document a true, accurate and complete disclosure of information.
Licensee Signature Date
Printed Name Title
ABC Office Use Only
☐APPROVED – Days Extended:
☐DENIED
Date Notified: By:
Method: ☐E-mail ☐Fax ☐Mail
Signature of ABC Official Date
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