Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Liquor License Application Form. This is a Kansas form and can be use in Alcohol Beverage Control Statewide.
Loading PDF...
Tags: Liquor License Application, ABC-800, Kansas Statewide, Alcohol Beverage Control
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
KANSAS LIQUOR LICENSE APPLICATION INSTRUCTIONS
GENERAL INSTRUCTIONS
Please complete all information. All questions must be answered fully and truthfully. You must submit your application
with original signatures. Completed applications are submitted to the Alcoholic Beverage Control at the address on the
form.
Application begins on page 4.
Additional information may be found on our website at
http://www.ksrevenue.org/abc.html
APPLICATION PREREQUISITES
1. You are required to obtain a Federal Employer Identification Number (FEIN) prior to submitting your application for
liquor licensure.
2. You must obtain your standard Tax Clearance Certificate prior to completing your application for liquor licensure.
Additional information is available on the Kansas Department of Revenue’s website. View this information and
request your tax clearance at: http://www.ksrevenue.org/taxclearance.html
ADDITIONAL STATE TAXATION REQUIREMENTS – BUSINESS TAX REGISTRATION
Your business must be registered with the Kansas Department of Revenue to collect and pay all applicable taxes,
including liquor drink, liquor enforcement, sales tax, withholding, etc. If you are required to collect Liquor Drink tax, you
must also post a Liquor Drink tax bond with the Director of Taxation.
To register, complete the KS-1216 Business Tax Application booklet and submit with your liquor license application or you
may register online at https://www.accesskansas.org/businesscenter/index.html
INSTRUCTIONS TO COMPLETE THE APPLICATION FOR LIQUOR LICENSE (ABC-800):
Applicants may apply for multiple licenses as permitted by law; however, the ownership must be exactly the same for
each of the licenses you are applying for.
Section 1 – Business Entity Information:
1. APPLICATION TYPE:
a. If you are applying for a new license(s), check the “New License” box, then check the appropriate box to
indicate the method selected for your business tax registration.
b. If you are renewing your license(s), check the “Renew License(s)” box and enter your expiration date. If you
have multiple licenses, enter the earliest license expiration date.
2. BUSINESS MAILING ADDRESS FOR ALL LICENSES. Enter the required mailing and contact information.
Section 2 – BUSINESS LOCATION INFORMATION
1. Check the appropriate box, new or renewal and enter the license type. If you are renewing your license, enter
your license number for the location.
2. Complete the required information. Attach additional pages for multiple locations as necessary.
Section 3 – License Types and Fees
1. LICENSE TYPE. Check the appropriate box for the type of license for which you are applying. If you are
applying for multiple licenses, check each license type.
2. QUANTITY. Enter the number of licenses you are applying for in both quantity columns.
3. REGISTRATION FEE. Check the appropriate box for either a new or renewal application.
4. TOTAL. Multiply the quantity times the license fee; multiply the quantity times the registration fee, then add the
two amounts together and enter that amount in the TOTAL column.
5. TOTAL FEES DUE. Add the amounts in the Total column, then enter the total amount into the TOTAL FEES
DUE box.
6. PAYMENT OPTION. Check one.
Section 4 – Business Ownership Information*
This information is required for individual owners; partners; all officers and directors of a corporation or LLC; and, anyone
with a financial interest, including spouses. The ownership must total 100%. Class A Clubs: officers enter a zero (0)
in the % Ownership.
1. Answer the ownership questions.
2. Complete the required information for each person with a financial interest in the business.
3. Attach additional pages as necessary and submit with your application.
NOTE: If you are applying for a Special Order Shipping license and are not located in Kansas, you are not required to
complete this section.
*See Social Security Number Disclosure statement on page 4.
ABC-800 (Rev. 7.1.12)
Page 1 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
Section 5 – Appointment of Process Agent with Power of Attorney*
The Process Agent is required for LLCs, Corporations and Municipal Corporations. They must be a Kansas resident and
they are required to provide spousal information if they are married.
1. Enter all required information for your Process Agent.
a. Check the box, “I am applying for a Special Order Shipping license and I have filed my Irrevocable Consent
to Jurisdiction with the Kansas Secretary of State. (Proceed to the next Section).
b. If you were required to file the Irrevocable Consent to Jurisdiction, attach a copy of this form that has been
stamped “FILED” by the Kansas Secretary of State’s office and submit with your new application for liquor
license. Not required to attach for renewal applications.
NOTE: If you are an out-of-state winery applying for a Special Order Shipping license, you must appoint the Kansas
Secretary of State as your process agent by filing the Irrevocable Consent to Jurisdiction form (ABC-160) with their office.
*See Social Security Number Disclosure statement on page 4.
Section 6 – Background Qualifications
Applicants, owners and process agents must meet certain qualifications required by the Liquor Control Act and the Club
and Drinking Establishment Act.
1. Check the appropriate box to answer each question truthfully for all applicants you have listed in Sections 4 and
5.
2. If the answer to any question is yes, you must provide an explanation on a separate page and attach to your
application.
Section 7 – Business Entity Information
1. GOOD STANDING. Your corporation, partnership, LLC or LLP must be in good standing with the Kansas
Secretary of State. You are required to attach a certificate of good standing which may be obtained from the
Secretary of State’s office for a fee; or, you may submit a business entity search results print from the Secretary
of State’s website at no charge. Go to: http://www.accesskansas.org/srv-corporations/compressed.do
If you do not have a corporation, partnership LLC or LLP, check the N/A box.
NOTE: If you are an out-of-state winery applying for a Special Order Shipping license, check the box, “I have filed my
Irrevocable Consent to Jurisdiction” and proceed to the business entity type section.
2. BUSINESS ENTITY TYPE. Check the box for your entity type and attach the required documentation to your
application as listed by your entity type.
NOTE: Corporations must be a Kansas corporation unless you are a an out-of-state winery applying for a Special Order
Shipping license, which requires filing the Irrevocable Consent to Jurisdiction (ABC-160). If you are an out-of-state winery
applying for a Special Order Shipping license, you are not required to submit documents.
Section 8 – Tax Clearance
All taxes due to the State of Kansas must be filed and paid prior to obtaining a liquor license.
1. Check the appropriate box to answer the question.
a. If you answered “Yes”, enter the confirmation number on your Tax Clearance certificate.
b. If you answered “No”, refer to the Application Prerequisite section on page 1 for information to obtain your
Tax Clearance certificate.
Section 9 – Premise(s) Information
Applicants must provide information regarding ownership of the proposed location. If you lease the premise, the lease
must be valid at the time of application.
1. Check the appropriate box for each question. If you answered “Yes” to any question, attach any required
information to your application.
2. If you have multiple locations, check the box “List attached for multiple locations” and attach the list to your
application.
NOTE: If you are an out-of-state winery applying for a Special Order Shipping license, you are not required to submit
documents.
Section 10 – Management Services Disclosure
Performance of management or operational services means the exercise of control by any person(s) or entity other than
the owner(s) or partners of a licensee on behalf of the licensee or its owner(s) or partners over the hiring, firing and/or
supervising of employees; ordering, inventory placement and coordinating order delivery to the store; advertising,
marketing or promotional programs enlisted, offered or utilized by the store; negotiating, entering into and/or execution of
contracts to which the store is a party; payment or authorization to pay for services provided to or purchases made by the
store; and performance of any other similar task(s) central to the operation or ability to operate the store.
1. Check the box to answer the question regarding use of management or operational services.
a. If you answered “Yes”, you must complete and attach the Management Services Information form (ABC807).
NOTE: Required for municipal corporations.
ABC-800 (Rev. 7.1.12)
Page 2 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
Section 11 – Determination of Food Sales Requirement
Applies to applicants who are also licensed food service establishments and are located in a county that requires 30% of gross
sales to be from food sales and to Class B Clubs who have reciprocal agreements and/or multiple ownership.
Section 12 – Authorized Person
You have the option to designate an authorized person or agent with whom the ABC may discuss your license and/or application
for liquor licensure. You may also designate this person as your primary contact person.
By designating an agent with whom the ABC may discuss your license and/or application, you and, if applicable, the entity, hereby
specifically authorize the ABC to share and discuss with such agent any and all information concerning your liquor license,
application or any legal proceedings taken by the ABC against your license. You may also appoint the agent as your Process
Agent with Power of Attorney.
The designation made pursuant to this form shall be effective until the ABC receives a notice withdrawing your appointment.
1. Check one box.
Section 13 – Application Oath
Read the application oath, then sign the application, enter the date signed, print your name and your title.
Finalizing Your Application:
Attach all required documentation to your application and the appropriate license fee(s) and registration fee(s) for each license.
You have the following payment options:
a. pay the license fee and registration fee in full; or,
b. pay ½ the license fee and the entire registration fee1. The remaining ½ of the license fee plus a 10% surcharge
must be paid within one year or your license will automatically be cancelled. (Refer to Section 3).
c. make your check or money order payable to the “Kansas Department of Revenue”.
Submit your application and payment to the address on the form.
Contact Information:
Questions may be directed to the ABC Licensing Unit.
Email: abc.licensing@kdor.ks.gov
Phone: 785-296-7015, press option #2
ABC-800 (Rev. 7.1.12)
Page 3 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
KANSAS LIQUOR LICENSE APPLICATION
SECTION 1 – BUSINESS ENTITY INFORMATION
Check one application type:
NEW LICENSE (check one):
I have completed my Business Tax Application (KS-1216) and will submit with my liquor license application.
I have registered for my business taxes online. https://www.accesskansas.org/businesscenter/index.html
RENEW LICENSE(S)
EXPIRATION DATE:
Business Mailing Address for All Licenses
FEIN:
Business Entity Name
Contact Person Name
Business Mailing Address
City
State
Business Phone No.
Zip
E-Mail Address
*Social Security Number
Under the Federal Privacy Act, disclosure of a social security number in this application is voluntary. If no
social security number is disclosed for each person listed in this application, a state issued driver’s license
number or government issued identification card number must be provided. Any social security number
provided may be forwarded to the Department of Social and Rehabilitative Services in compliance with K.S.A.
39-758.
ABC OFFICE USE ONLY:
License Fee
Registration Fee
Associate Initials/Date
Full
Amount $____________________
$50 New License
$10 Renew License
st
Amount $____________________
$50 New License
$10 Renew License
1 Half
ALCOHOLIC BEVERAGE CONTROL DIVISION
LICENSE FEE VOUCHER
DBA Name:
TOTAL AMOUNT
License Number(s):
Full License Fee:
$
1st Half License Fee:
$
ABC-800 (Rev. 7.1.12)
CLFE
CLPR
CLFE
CLPR
Registration Fee: (CLPR)
Registration Fee: (CLPR)
$50 New License
$10 Renewal
$50 New License
$10 Renewal
$
$
Page 4 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
FEIN_______________________
SECTION 2 – BUSINESS LOCATION INFORMATION
Location Information
Check One:
New License
License Type: _____________________________________
Renew License No. _____________________________________________
Location DBA Name
Location Street Address
City
County
Business Phone No.
E-Mail Address
Location Information
Check One:
State
New License
Zip
License Type: _____________________________________
Renew License No. _____________________________________________
Location DBA Name
Location Street Address
City
County
Business Phone No.
E-Mail Address
Location Information
Check One:
State
New License
Zip
License Type: _____________________________________
Renew License No. _____________________________________________
Location DBA Name
Location Street Address
City
County
Business Phone No.
E-Mail Address
Location Information
Check One:
State
New License
Zip
License Type: _____________________________________
Renew License No. _____________________________________________
Location DBA Name
Location Street Address
City
County
Business Phone No.
E-Mail Address
Location Information
Check One:
State
New License
Zip
License Type: _____________________________________
Renew License No. _____________________________________________
Location DBA Name
Location Street Address
City
County
Business Phone No.
E-Mail Address
Location Information
Check One:
State
New License
Zip
License Type: _____________________________________
Renew License No. _____________________________________________
Location DBA Name
Location Street Address
City
County
Business Phone No.
E-Mail Address
ABC-800 (Rev. 7.1.12)
State
Zip
Page 5 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
SECTION 3 – LICENSE TYPES and FEES
License Type
QTY
Class A Club (Fraternal/Veterans)
Class A Club – Social (500 members or less)
Class A Club – Social (Over 500 members)
Class B Club
Caterer
DE/Caterer
Drinking Establishment (DE)
Hotel
Hotel/Caterer
Public Venue – up to 10,000 persons
Public Venue – up to 25,000 persons
Public Venue – more than 25,000 persons
x
x
x
x
x
x
x
x
x
x
x
x
x
Two Year
License
Fee
$ 500
$1,000
$2,000
$2,000
$ 1,000
$3,000
$2,000
$6,000
$7,000
$5,000
$7,500
$10,000
$ 500
Retailer
$ 100
Microbrewery
x
x
x
Microbrewery
Packaging and Warehousing Facility
x
$ 200
Microdistillery
x
$ 500
Microdistillery
Packaging and Warehousing Facility
x
$ 200
Manufacturer – Alcohol & Spirits
x
x
$5,000
x
x
x
x
x
x
x
x
x
x
x
$2,000
x
x
x
x
x
x
$
Farm Winery
Farm Winery Outlet
Manufacturer – Wine
$ 500
$ 500
$1,000
+
QTY
x
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
x
x
x
x
x
x
x
x
x
x
x
x
Registration Fee
Add Fee for each License
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
x
x
x
x
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
x
x
New $50
Renew $10
New $50
Renew $10
x
x
New $50
Renew $10
New $50
Renew $10
+
+
+
+
+
+
+
+
+
+
+
x
x
x
x
x
x
x
x
x
x
x
New $50
+
+
+
+
+
+
x
x
x
x
x
x
=
Total
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
=
=
=
=
=
=
=
=
=
=
=
$
$
$
$
$
$
$
$
$
$
$
=
=
=
=
=
=
$
$
$
$
$
$
$
$
$
$
$
Manufacturer – Beer and CMB
First Year
1-100 Barrels
100-150 Barrels
150-200 Barrels
200-300 Barrels
300-400 Barrels
400-500 Barrels
500 or more Barrels
Wine Distributor
Beer Distributor
Spirits Distributor
$ 400
$ 800
$1,400
$2,000
$2,600
$2,800
$3,200
$2,000
$2,000
$2,000
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
New $50
Renew $10
Non-Beverage User (Fee Based on Usage)
Class 1 – up to 100 Gallons
Class 2 – up to 1,000 Gallons
Class 3 – up to 5,000 Gallons
Class 4 – up to 10,000 Gallons
Class 5 – over 10,000 Gallons
Special Order Shipping
20
$ 100
$ 200
$ 400
$1,000
$ 100
Payment Option: (check one):
License fee and registration fee in full.
st
1
1 half license fee plus the entire registration fee .
1
TOTAL FEES DUE $
If you select this option, you must submit the 2nd half license fee plus a 10% surcharge within one year or your license will be automatically cancelled.
ABC-800 (Rev. 7.1.12)
Page 6 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
FEIN_______________________
SECTION 4 – BUSINESS OWNERSHIP INFORMATION
Primary contact person with whom the ABC should contact for licensing questions: (check one):
Owner/Officer (check only one “yes” from officers/owners below)
Process Agent (Section 5)
Authorized Person (Section 12)
Yes (proceed to Section 5)
Is the applicant a municipal corporation?
No (proceed to next question)
Yes (complete for corporate officers and spouses and anyone with 5% or
more ownership)
Is this a publically traded company?
No (complete ownership information below for all owners)
The following information must be provided on the applicant(s); individual owners; partners; all officers and directors (if a corporation
or LLC); and anyone with a financial interest, AND the spouses of all submitted persons. (Attach additional pages as necessary). The
percentage(s) of ownership must total 100%. Class A Clubs: officers enter a zero (0) in the % Ownership.
President or Equivalent
Primary Contact:
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
Marital Status:
DL State
State
Married (complete spousal information)
Single
Gender
County
Yes
No
Date of Birth
% Ownership
Zip Code
Daytime Phone
Gender
Date of Birth
Email Address
Officer Spousal Information
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
DL State
State
County
% Ownership
Zip Code
Vice President or Equivalent
Primary Contact:
Last Name
First Name
Social Security Number*
Address
City
Middle Name
Driver’s License No.
Marital Status:
Daytime Phone
DL State
State
Married (complete spousal information)
Single
Gender
County
Yes
No
Date of Birth
% Ownership
Zip Code
Daytime Phone
Gender
Date of Birth
Email Address
Officer Spousal Information
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
DL State
State
County
% Ownership
Zip Code
Secretary or Equivalent
Primary Contact:
Last Name
First Name
Social Security Number*
Address
City
Middle Name
Driver’s License No.
Marital Status:
Daytime Phone
DL State
State
Married (complete spousal information)
Single
Gender
County
Yes
No
Date of Birth
% Ownership
Zip Code
Daytime Phone
Gender
Date of Birth
Email Address
Officer Spousal Information
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
ABC-800 (Rev. 7.1.12)
DL State
State
County
% Ownership
Zip Code
Daytime Phone
Page 7 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
FEIN_______________________
Treasurer or Equivalent
Primary Contact:
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
Marital Status:
DL State
State
Married (complete spousal information)
Single
Gender
County
Yes
No
Date of Birth
% Ownership
Zip Code
Daytime Phone
Gender
Date of Birth
Email Address
Officer Spousal Information
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
DL State
State
County
% Ownership
Zip Code
Other
Primary Contact:
Last Name
First Name
Social Security Number*
Address
City
Middle Name
Driver’s License No.
Marital Status:
Daytime Phone
DL State
State
Married (complete spousal information)
Single
Gender
County
Yes
No
Date of Birth
% Ownership
Zip Code
Daytime Phone
Gender
Date of Birth
Email Address
Other Spousal Information
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
DL State
State
County
% Ownership
Zip Code
Other
Primary Contact:
Last Name
First Name
Social Security Number*
Address
City
Middle Name
Driver’s License No.
Marital Status:
Daytime Phone
DL State
State
Married (complete spousal information)
Single
Gender
County
Yes
No
Date of Birth
% Ownership
Zip Code
Daytime Phone
Gender
Date of Birth
Email Address
Other Spousal Information
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
ABC-800 (Rev. 7.1.12)
DL State
State
County
% Ownership
Zip Code
Daytime Phone
Page 8 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
FEIN_______________________
Other
Primary Contact:
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
Marital Status:
DL State
State
Married (complete spousal information)
Single
Gender
County
Yes
No
Date of Birth
% Ownership
Zip Code
Daytime Phone
Gender
Date of Birth
Email Address
Other Spousal Information
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
DL State
State
County
% Ownership
Zip Code
Other
Primary Contact:
Last Name
First Name
Social Security Number*
Address
City
Middle Name
Driver’s License No.
Marital Status:
Daytime Phone
DL State
State
Married (complete spousal information)
Single
Gender
County
Yes
No
Date of Birth
% Ownership
Zip Code
Daytime Phone
Gender
Date of Birth
Email Address
Other Spousal Information
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
DL State
State
County
% Ownership
Zip Code
Other
Primary Contact:
Last Name
First Name
Social Security Number*
Address
City
Middle Name
Driver’s License No.
Marital Status:
Daytime Phone
DL State
State
Married (complete spousal information)
Single
Gender
County
Yes
No
Date of Birth
% Ownership
Zip Code
Daytime Phone
Gender
Date of Birth
Email Address
Other Spousal Information
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
ABC-800 (Rev. 7.1.12)
DL State
State
County
% Ownership
Zip Code
Daytime Phone
Page 9 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
FEIN_______________________
SECTION 5 – APPOINTMENT OF PROCESS AGENT WITH POWER OF
ATTORNEY (Required for LLC, Corporations and Municipal Corporations)
I am applying for a Special Order Shipping license and I have filed my Irrevocable Consent to Jurisdiction with the Kansas Secretary
of State. (Proceed to Section 7).
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
Gender
Date of Birth
DL State
State
County
% Ownership
Zip Code
Daytime Phone
Gender
Date of Birth
KS
Marital Status:
Married (complete spousal information)
Single
Email Address
Process Agent Spousal Information
Last Name
First Name
Social Security Number*
Driver’s License No.
Address
City
Middle Name
DL State
State
County
% Ownership
Zip Code
Daytime Phone
KS
SECTION 6 – BACKGROUND QUALIFICATIONS
If the answer to any question is yes, provide explanation on separate page and attach to your application.
1. Has any person listed in Sections 4 and 5 been convicted of a felony in Kansas, in any other state, or under
federal law? If yes, provide the following:
State of conviction:_________ Case #:_________________ Name of charge:________________________
Yes
No
2. Has any person listed in Sections 4 and 5 been convicted of a morals charge (prostitution; procuring any
person; solicitation of a child under 18 for immoral act involving sex; possession or sale of narcotics,
marijuana, amphetamines or barbiturates; rape; incest; gambling; adultery; or bigamy) in Kansas or any other
state? If yes, provide the following:
State of conviction:_________ Case #:_________________ Name of charge:________________________
Yes
No
3. Has any person listed in Sections 4 and 5 had an alcoholic liquor or cereal malt beverage license revoked in
Kansas or in any state? If yes, provide the following:
State:_________ DBA Name:________________________________ Date of revocation:______________
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
4. Is any person listed in Sections 4 and 5 currently a law enforcement officer or non-elected official who
supervises or appoints any law enforcement officer?
5a. Does any person listed in Sections 4 and 5 have an ownership interest in any other business licensed to sell
alcoholic liquor in Kansas? If yes, provide the following (you may attach a list as required):
DBA Name(s):_______________________________ License Number(s):___________________________
5b. Does any person listed in Sections 4 and 5 have an ownership interest in any other business licensed to sell
cereal malt beverage in Kansas? If yes, provide the following:
License #: ________________________________
6. Does any person listed in Sections 4 and 5 not meet the Kansas residency requirement for the type of
license applied for? (Class A & B Club, Drinking Establishment – 1 year; Farm Winery or Microbrewery – 1
year; Retailer – 4 years; Manufacturer – 5 years).
7a. Is any person listed in Sections 4 and 5 not a US Citizen? If yes, explain:____________________________
_______________________________________________________________________________________
7b. Has any person listed in Sections 4 and 5 not been a US Citizen for at least 10 years? If yes, explain:______
_______________________________________________________________________________________
ABC-800 (Rev. 7.1.12)
Page 10 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
FEIN_______________________
SECTION 7 – BUSINESS ENTITY INFORMATION
I am applying for a Special Order Shipping license and I have filed my Irrevocable Consent to Jurisdiction with the Kansas Secretary
of State. (Proceed to business entity type).
Is your Corporation, Partnership, LLC or LLP in good standing with the Kansas Secretary of State?
Yes*
No
*If yes, attach a Certificate of Good Standing (requires fee) or search results print out from the
Secretary of State’s website (no charge) to the application. To print from the Secretary of State’s
N/A
website, go to: http://www.accesskansas.org/srv-corporations/compressed.do
Check one of the following business entity types:
Individual
Is the applicant a resident of Kansas?
Yes
No
I live in ______________________________________ county.
Corporation – Attach a copy of the Articles of Incorporation and By-Laws to your application. (New applicants only).
General Partnership – Attach a copy of the Partnership Agreement to your application. (New applicants only).
Partners live in the following county(ies):
LLC or LLP – Attach a copy of the Articles of Organization and Operating Agreement. (New applicants only).
Trust – Attach a copy of the Declaration Of Trust.
Municipal Corporation – (Requires Process Agent and Management Services Agreement).
Government – (check one):
City
County
State
Federal
Other:
SECTION 8 – TAX CLEARANCE
Has the applicant obtained their Tax Clearance certificate?
*If yes, enter your Tax Clearance confirmation number:_______________________________________
**If no, you must request your Tax Clearance certificate.
To obtain your tax clearance, go to: http://www.ksrevenue.org/taxclearance.html after saving this document
Yes*
No**
Yes*
No
Yes*
No
Yes*
No
Yes*
No
Yes*
No
SECTION 9 – PREMISE(S) INFORMATION
List attached for multiple locations
Does the applicant own the proposed location?
*If yes, attach a copy of the Deed to the application. (New applicants only).
Does the applicant have a purchase agreement for the proposed location?
*If yes, attach a copy of the Purchase Agreement to the application. (New applicants only).
Does the applicant lease the proposed location?
*If yes, attach a copy of the Lease to the application. (New applicants or renewal applicants with lease
changes).
Lease End Date: _______________________
Is the premise(s) owned by a city or county, or is this a stadium, arena, convention center, theater, museum,
amphitheater or other similar premises?
*If yes, attach a copy of the Executed Agreement for alcoholic beverage services to the application.
(New applicants or renewal applicants with changes).
Executed Agreement End Date: ______________________
SECTION 10 – MANAGEMENT SERVICES DISCLOSURE
Will any person/entity other than the owner(s) or partners be engaged or contracted to perform
management or operational services?
*If yes, you must complete and attach the Management Services Information (ABC-807)
ABC-800 (Rev. 7.1.12)
Page 11 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
FEIN_______________________
SECTION 11 – DETERMINATION OF FOOD SALES REQUIREMENT
1
A. Is your business also a licensed food service establishment as defined by K.S.A. 36-501?
*If yes, proceed to “B” below.
**If no, proceed to the next Section.
Yes*
No**
Yes*
No**
Yes*
No**
Yes*
No**
Yes*
No**
Yes*
No**
1
Food – means any raw, cooked or processed edible substance or ingredient, other than alcoholic liquor or cereal malt beverage
used or intended to use or for sale, in whole or in part, for human consumption.
B. Are you applying for or renewing a private club license?
*If yes, select your private club class type below and answer the questions.
**If no, proceed to “C” below.
CLASS A CLUB:
Do you have reciprocal agreements that are not listed in your charter?
*If yes, attach copies of your reciprocal agreements outside those listed in your charter. Proceed
to next Section.
**If no, proceed to next Section.
CLASS B CLUB:
Do you own multiple Class B Clubs? (If yes, 50% food sales requirement applies).
Do you have reciprocal agreements? (If yes, 50% food sales requirement applies).
*If yes, attach copies of your reciprocal agreements. Proceed to “D” below.
**If no, proceed to next Section.
C. Is there a 30% food sales requirement in your county?
*If yes, proceed to “D” below.
**If no, proceed to the next Section.
To check for food sales requirements in your county, go to: http://www.ksrevenue.org/abcwetdrymap.html
D. Statement of Gross Receipts (select one):
I am applying for a new license. I understand that I must meet the 30% food sales requirement during the license term. (50% food sales
requirement for Class B Clubs with reciprocal agreements and/or multiple ownership).
I am renewing my license. I understand that I must meet the 30% food sales requirement during the license term. (50% food sales
requirement for Class B Clubs with reciprocal agreements and/or multiple ownership).
Enter the following information: License Year: ____________ to ____________
Month/Year
Month/Year
soeriop
Gross Receipts1: $____________________
Food Income2:
$____________________
Percentage of Food Income: ____________%
1
Gross Receipts for Drinking Establishments, Caterers or Hotels – includes all sales of food and beverages sold on the premises
Gross Receipts for Private Clubs – includes sales of any type made on the licensed premises including food, alcohol, membership fees, cover
charges, vending machine concessions, video games and other sales.
2
Food Income – means the gross receipts from the sale of food on the licensed premises only and does not include income derived from the sale of items
mixed with alcoholic liquor or cereal malt beverage.
1
ABC-800 (Rev. 7.1.12)
Page 12 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com
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
FEIN_______________________
SECTION 12 – AUTHORIZED PERSON TO DISCUSS MY LICENSE AND/OR
APPLICATION WITH ABC
Check one:
I designate the following person.
I designate the following person/agent as my primary contact. (Check this box only if indicated in Section 4).
I do not wish to designate a person.
Name
Address
Daytime Phone
City
State
Zip Code
E-Mail Address
SECTION 13 – APPLICATION OATH
Under penalties of perjury, I declare the information contained in this document and all application materials represents a true, accurate and
complete disclosure of information.
I hereby authorize disclosure and investigation of my financial records, including those held by third parties, to duly authorized agents of the
Director of Alcoholic Beverage Control as necessary to determine qualification for licensure. I also authorize KDOR to send
communications to the e-mail address provided on this form. Furthermore, if a Corporation or LLC, I appoint the Process Agent with Power
of Attorney identified in Section 5, who is a United States citizen and a Kansas resident, upon whom process may be served in any action
brought against it.
__________________________________________________________________________________________________________________
Signature of Applicant
Date
__________________________________________________________________________________________________________________
Printed Name
Title
Clear Form
ABC-800 (Rev. 7.1.12)
Page 13 of 13
American LegalNet, Inc.
www.FormsWorkFlow.com