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
ABC-838 (Rev. 07/18)
REQUEST TO PARTICIPATE IN COMMON CONSUMPTION AREA
WHO IS REQUIRED TO COMPLETE THIS FORM?
On-Premise licensees and temporary permit holders immediately adjacent to or located within a permitted Common Consumption Area who wish to participate in the
Common Consumption Area.
INSTRUCTIONS TO COMPLETE THE REQUEST TO PARTICIPATE IN COMMON CONSUMPTION AREA (ABC-838):
Complete this form and return to the address or fax number above or e-mail to KDOR_ABC.Licensing@ks.gov. Once approved, the licensee may allow patrons to
remove alcoholic liquor purchased from the licensee into the premise described by ordinance or resolution for the Common Consumption Area.
SECTION 1 – LICENSEE INFORMATION:
Licensee DBA Name License Number Common Consumption Area Permit Number
Requestor Name E-mail Address
Business Phone Number Cell Phone Number
SECTION 2 – DIAGRAM:
In the space below, in ink, draw a sketch of the licensed premise and the Common Consumption Area being requested to participate in or attach your drawing,
provided it is not larger than 8½” X 11”. The diagram must include the boundaries of the Common Consumption Area. Architectural drawings are not accepted.
Check one: ☐Diagram drawn ☐8½” X 11” drawing attached
The above named licensee, does hereby request to participate in a Common Consumption Area. In making this request, the above licensee understands that:
a. They will comply with the ordinance or resolution established for the Common Consumption Area.
b. All alcoholic beverages removed from the licensee’s licensed premise must be in a container that displays the licensee’s trade name, logo or other identifying mark
that is unique to the licensee.
c. They are liable for violations of all liquor laws governing the sale and consumption of alcoholic liquor that occur on the licensee’s licensed premise.
d. If they choose to cancel their participation in a Common Consumption Area, they must submit a request in writing to the ABC to withdraw their participation.
e. They will keep the approved copy of this form (ABC-838) on the licensed premise.
f. They will ensure the Common Consumption Area Permit is active prior to allowing patrons to remove alcoholic liquor from the licensed premise into the Common
Consumption Area.
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
Request Approved
☐ Request Denied
Reason Denied:
Signature of ABC Official Date
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signature
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