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T www.ksrevenue.org/abc.html A 109 SW 9 STREET P (Kansas Department of Revenue)

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A
LCOHOLIC BEVERAGE CONTROL
109 SW 9
th
STREET
P.O. BOX 3506
T
OPEKA KS 66601-3506
DEPARTMENT OF REVENUE
P
HONE: 785-296-7015
F
AX: 785-296-7185
www.ksrevenue.org/abc.html
ABC-828 (Rev. 07/18)
PACKAGING AND WAREHOUSING FACILITY PERMIT APPLICATION AND AGREEMENT INSTRUCTIONS
WHO CAN APPLY FOR THIS PERMIT?
This permit is available to any manufacturer or supplier of alcoholic liquor or cereal malt beverage, whether licensed in this state or any other state.
REQUIREMENTS TO OBTAIN A KANSAS PACKAGING AND WAREHOUSING FACILITY PERMIT?
A. Packaging and Warehousing Facility Permit Application and Agreement (ABC-828).
B. $2,500.00 annual permit fee.
C. Request for Premises Approval (ABC-806).
D. Irrevocable Consent to Jurisdiction form (ABC-160). If your company is not located in Kansas, you are required to file the Irrevocable Consent to Jurisdiction for
(ABC-160) with the Kansas Secretary of State’s Office. The Secretary of State’s Office will return to you a copy of the ABC-160 form that has been stamped
“FILED”. You must then provide the ABC with a copy that has been stamped “FILED” along with your Application and Agreement.
E. Copy of your Basic Permit or Brewer’s Notice.
F. Copy of your valid Manufacturer or Supplier license in this state or any other state.
COMPLETING THE KANSAS PACKAGING AND WAREHOUSING FACILITY PERMIT APPLICATION AND AGREEMENT (ABC-828):
1. Permit Type.
a. New Permit. Check the “New Permit” box if you do not have a Kansas Packaging and Warehousing Facility Permit or if your Kansas Packaging and
Warehousing Facility Permit has been expired for more than 30 days.
b. Renew Permit. Check the “Renew Permit” box to renew your current Kansas Packaging and Warehousing Facility Permit.
2. Check your appropriate “Application Entity Type”, complete, sign and date the Kansas Packaging and Warehousing Facility Application and Agreement form, print
your name and title.
3. Make a copy of the completed Packaging and Warehousing Facility Permit Application and Agreement. Retain the copy for your records.
4. Complete the attached Packaging and Warehouse Facility Permit Voucher.
a. New Permit. Check the “New Permit” box, enter the name as it appears on the Packaging and Warehousing Facility Permit Application and Agreement and
the date completed. Attach a copy of your Federal Basic Permit or Brewer’s Notice, a copy of your valid Manufacturer or Supplier license and a copy of th
e
F
iled Irrevocable Consent to Jurisdiction (ABC-160) if your business is not located in Kansas.
b. To Renew Permit. Check the “Renew Permit” box, enter your Supplier Name, Packaging and Warehousing Facility Permit Number and the date completed
and attach a copy of your valid Manufacturer or Supplier license.
5. Make your check payable to the “Kansas Department of Revenue” and attach it to the completed Packaging and Warehousing Facility Permit Voucher below.
6. Return the original completed Packaging and Warehousing Facility Permit Application and Agreement and the $2,500.00 Packaging and Warehousing Facility
Permit fee to the ABC Marketing Unit with the required documentation.
To obtain additional information, visit our website at: http://ksrevenue.org/abcpackaging.html.
Direct your questions to the Marketing Unit at 785-296-7015 or e-mail to KDOR_ABC.Marketing.Unit@ks.gov
Detach and Return with Payment
KANSAS ALCOHOLIC BEVERAGE CONTROL DIVISION
PACKAGING AND WAREHOUSING FACILITY PERMIT FEE VOUCHER
Applicant DBA Name:
☐$2,500.00 Permit Fee Enclosed (CLPR)
☐ New Permit
Attach the following:
☐ Request for Premise Approval (ABC-806)
☐ Copy of your Federal Basic Permit or Brewer’s Notice
☐ Copy of your filed Irrevocable Consent to Jurisdiction (ABC-160) ☐Not required (Company is located in Kansas)
☐ Copy of your valid Manufacturer or Supplier license
☐ Renew Permit Number:
☐ Attach a copy of your valid Manufacturer or Supplies license.
STATE OF KANSAS
A
LCOHOLIC BEVERAGE CONTROL
109 SW 9
th
STREET
P.O. BOX 3506
T
OPEKA KS 66601-3506
D
EPARTMENT OF REVENUE
PHONE: 785-296-7015
F
AX: 785-296-7185
www.ksrevenue.org/abc.html
ABC-828 (Rev. 04/19)
KANSAS PACKAGING AND WAREHOUSING FACILITY PERMIT
APPLICATION AND AGREEMENT
Permit Type (check one):
☐New Permit ☐Renew Permit
Applicant Entity Type (check one): ☐Individual ☐Corporation ☐Partnership ☐LLC ☐LLP
Permit Number (renew permit only) FEIN Phone
DBA Name Entity Name
Location Address City State Zip Code
Mailing Address City State Zip Code
Contact Person E-mail Address
Does your company use a compliance agency?
☐Yes* ☐
*If yes, complete the compliance agency information.
No
Compliance Agency Name
Compliance Agency Mailing Address City State Zip Code
Compliance Agency Contact Person Name Compliance Agency Phone
The above named manufacturer or supplier does hereby make application for a Packaging and Warehousing Facility Permit. In making this application, the above
named manufacturer or supplier agrees that:
a. It may transfer alcoholic liquor or cereal malt beverage to the licensed premises of a packaging and warehousing facility for the purpose of packaging or storage
o
f both.
b. It may sell and transfer from the licensed premises of a packaging and warehousing facility to the licensed premises of a spirits, wine or beer distributor licensed
in Kansas or to a Kansas s
upplier.
c. It may tr
ansfer from the licensed premises of a packaging and warehousing facility to another state.
d. It will register with the Director each brand and label of alcoholic liquor and/or cereal malt beverage transported to or stored at a licensed packaging and
warehousing facility that is intended for sale to distributors in Kansas prior to making shipments to licensed distributors in this state.
e. It hereby appoints the Kansas Secretary of State its resident agent and representative authorized to accept service of any notice or order and that all such acts by
the Secretary of State shall be fully binding upon the manufacturer or supplier.
f. It will abide by all the provisions of the Kansas Liquor Control Act and the Rules and Regulations promulgated thereunder.
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
FOR OFFICE USE ONLY:
☐ $2,500 Permit Fee Received Date Initials
☐ New Permit Approved Date Expires Completed by: Date:
☐ Renew Permit From to Completed by: Date:
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T www.ksrevenue.orgabc.html A 109 SW 9 STREET P (Kansas Department of Revenue)

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Completed 24 August 2020

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