Kansas Department of Revenue Alcoholic Beverage Control Division 915 S.W. Harrison Street, Room 214 Topeka, KS 66625-3512 Phone: 785-296-7015 Fax: 866-855-5025 ESCROW BOND FOR LIQUOR LICENSES ISSUED UNDER THE LIQUOR CONTROL ACT Pursuant to K.S.A. 41-317 KNOW ALL MEN BY THESE PRESENTS: That we ________________________________ and ________________________________ do hereby enter into (Depositor) (Escrow Agent) this agreement in compliance with K.S.A. 41-317(b) and K.A.R. 14-7-4. WHEREAS, the Depositor has applied for or has been licensed by the Director of the Alcoholic Beverage Control Beer Distributor Spirits Distributor Wine Distributor Division of the State of Kansas as a: Retailer Farm Winery Microbrewery Microdistillery Manufacturer Non-Beverage User Special Order Shipping Public Venue Depositor agrees to purchase and deliver to Escrow Agent a certificate of deposit issued by a Kansas bank or savings and loan association in the amount of $__________, which is the amount established by Kansas law as the required bond. Depositor shall not assign, transfer, alienate, pledge as security for any loan, or otherwise encumber the certificate during the period of this agreement. Escrow Agent acknowledges receipt of the certificate of deposit numbered ___________________ and shall not return said certificate to Depositor nor permit said certificate to be assigned, transferred, alienated, pledged, or otherwise encumbered during the period of this agreement except as provided below. Escrow Agent shall remit interest on the certificate annually to Depositor. Upon written demand from the Director of the Alcoholic Beverage Control, should Depositor default in payment of any fees, fines or taxes to the Kansas Department of Revenue, Escrow Agent shall remit the value of the certificate and any unpaid interest accrued through the date of notification to the Alcoholic Beverage Control. Upon remittance, this agreement shall be deemed terminated. Upon written notice from the Director of the Alcoholic Beverage Control that a bond is no longer required for Depositor, Escrow Agent shall release the certificate to Depositor. This agreement shall terminate upon such release. Nothing in this agreement shall be construed to increase Escrow Agent’s liability beyond the amount of the certificate and the express provisions of this agreement. This bond shall be effective on and after the __________ day of ___________________, _________, unless (Day) (Month) (Year) terminated as specified above. Witness our hands at ____________________, ________, this _______ day of ________________, __________. (City) (State) (Day) (Month) (Year) ESCROW AGENT (please print) Signature of Escrow Agent Escrow Agent’s Name Mailing Address Area Code and Phone Number DEPOSITOR or AGENT (please print) Signature of Depositor or Agent Title of Depositor Depositor or Agent Name Mailing Address Area Code and Phone Number NOTARY Subscribed and sworn to before me this ___________ day of _______________, _______ _____________________________________ Notary Public My commission expires: _________________________ For ABC Office Use Only License Number(s): Rep’s Initials: Bond Demand Amount $ Date: Rep’s Initials: FEIN: Date: Bond Release Date: Rep’s Initials: ABC-803 (Rev. 7.1.12) American LegalNet, Inc. www.FormsWorkFlow.com