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 FOR APPROVAL
SALE OF INVENTORY OF ALCOHOLIC LIQUOR OR CMB
This request must be submitted AND approved prior to transfer of any inventory. If inventory is being sold to more than one licensee, complete and submit
the ABC-812 for each transaction.
SECTION 1 – Seller Information:
License Number:
Licensee Owner Name:
Licensee DBA Name:
Address:
City / State / Zip Code:
Phone Number: E-mail Address:
I request permission to sell all or part of my inventory of alcoholic beverages to the licensee listed below.
Signature Date
SECTION 2 – Purchaser Information:
License Number:
Licensee Owner Name:
Licensee DBA Name:
Address:
City / State / Zip Code:
Phone Number: E-mail Address:
I request permission to purchase all or part of my inventory of alcoholic beverages to the licensee listed above.
Signature Date
ABC OFFICE USE ONLY:
Tax Clearance: ☐Yes ☐No
Associate:
Date
Fine Clearance: ☐Yes ☐No
Associate:
Date
Request for Sale: ☐Yes ☐No
Signature of ABC Director
Date
Licensee Notification: ☐Yes ☐No
Signature of ABC Licensing Customer Rep
Date
ABC-812 (Rev. 07/18) Page 1 of 2
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