Fillable STATE OF KANSAS RETURN KEG TAGS F TOPEKA (Kansas Department of Revenue)

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STATE OF KANSAS RETURN KEG TAGS F TOPEKA (Kansas Department of Revenue)

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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
RETURN KEG TAGS
Please complete and return this form when returning unused keg tags to the Alcoholic Beverage Control.
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:
Keg Tag Information:
Tag Number(s) Returned: Quantity:
Name of Person Returning Keg Tags:
Signature of Person Returning Keg Tags Date
ABC Office Use Only:
Keg Tag Numbers Returned to Inventory:
Quantity Returned:
Date Returned to Inventory:
Completed By:
ABC-173 (Rev. 02/18)
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STATE OF KANSAS RETURN KEG TAGS F TOPEKA (Kansas Department of Revenue)

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Completed 24 August 2020

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