KANSAS DEPARTMENT OF REVENUE ALCOHOLIC BEVERAGE CONTROL DIVISION ESCROW AGREEMENT FOR GUARANTEE OF KANSAS RETAIL LIQUOR EXCISE TAX LIABILITY This agreement entered into this ____________ day of ________________, _______, between _________________________ ______________________________________, hereinafter referred to as the "Escrow Agent" and _____________________________ _________________________________________________________________________ hereinafter referred to as the "Depositor" is (Underline one - Individual Proprietorship, Partnership, LLC or Corporation) entered into to comply with the requirements of K.S.A. 79-41a03 as amended. The Depositor agrees to purchase and deliver to the Escrow Agent a certificate of deposit issued by a Kansas bank, savings and loan association, or credit union in the amount of $____________, which amount the Depositor warrants is the amount established by the Kansas Department of Revenue as the required bond. The Depositor may not assign, pledge as security for any loan, or otherwise encumber the certificate during the period of this agreement. For the privilege of operating a licensed establishment to sell alcoholic liquor in the State of Kansas, Depositor hereby grants the Kansas Department of Revenue a security interest in the following described property: certificate of deposit number ____________________, in the amount of $____________, to be held in trust by the Escrow Agent for the Kansas Department of Revenue to secure the payment of liquor excise tax pursuant to the Kansas Retail Liquor Excise Tax Act. The Escrow Agent hereby acknowledges receipt of notification of the Kansas Department of Revenue's security interest in the above described property. The Escrow Agent acknowledged receipt of the aforesaid certificate of deposit and will not return said certificate to the Depositor nor allow said certificate to be assigned, pledged, or otherwise encumbered during the period of this agreement except as provided below. The Escrow Agent shall remit interest on the certificate annually to the Depositor. In the event Depositor defaults in payment of the Kansas Liquor Excise tax obligations, the Escrow Agent, upon written demand from Kansas Department of Revenue, shall remit the proceeds of the certificate of deposit and any interest accrued to date of notification to the Kansas Department of Revenue or its authorized agent. Upon such remittance to the Kansas Department of Revenue, this agreement shall be deemed terminated. When the Director of Taxation of the State of Kansas determines that a bond is no longer required for the Depositor, notification in writing shall be made to the Escrow Agent who will then be authorized to release the certificate of deposit to the Depositor and thus terminate this agreement. Nothing in this agreement shall be so construed to increase the liability of the Escrow Agent beyond the amount and provisions of this agreement. Dated at _____________________________________ this ____________ day of ___________________________, ________ __________________________________________________ Depositor's Signature __________________________________________________ Depositor's Address __________________________________________________ Escrow Agent's Signature __________________________________________________ Address __________________________________________________ Liquor Excise Tax Reg. No. State of County of __________________________________________ ss Subscribed and Sworn to before me this ____________ day of ____________________, 19_______. __________________________________________________ Notary Public My Commission Expires ABC-401 (Rev. 3/04) American LegalNet, Inc. www.FormsWorkflow.com