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_______________________ ZONING Applicant/Owner Name DBA Name of Business Business Location Address City Township State Business Phone No. Zip Applicant/Owner Phone No. Type of License Sought: Caterer Distributor Drinking Establishment Drinking Establishment/Caterer Farm Winery Farm Winery Outlet Hotel/Caterer Hotel Manufacturer Microbrewery Microbrewery Packaging/Warehouse Microdistillery Microdistillery Packaging/Warehouse Non-Beverage User Public Venue Private Club: A or B Retailer NOTICE TO CITY/COUNTY CLERK: Submission of this zoning form by the applicant to the City or County constitutes notification to the governmental entity that an application for a liquor license has been or will be received by the ABC. Should the City or County you represent desire to make any comments, suggestions or recommendations relative to the granting of or refusal to grant a license to the above-named applicant; or, the premise for which licensure is sought or to request a hearing pursuant to K.S.A. 41-318 or 41-2608, it may do so by submitting such comments, suggestions, recommendations or requests to the ABC within 10 days of the date you affix your seal to this document. You may submit your written request to the address or fax number provided at the top of the form. CERTIFICATE OF CITY, TOWNSHIP OR COUNTY CLERK I HEREBY CERTIFY THAT THE PREMISES IS: (check one box in each section): CITY LIMITS: Inside the incorporated city limits Outside the city limits RETAILERS ONLY: K.S.A. 41-303 states no license shall be granted to any applicant unless: 1. The premise to be licensed is located in a township with a population of at least 5,000; and, 2. the board of county commissioners has adopted a resolution approving the issuance of a license to the location. A certified copy of such resolution must accompany the license application. ZONING: within an area that complies with all applicable zoning regulations required by K.S.A. 41-710 or K.S.A. 41-2608. Farm Wineries and Microbreweries must be zoned agricultural, commercial or business as required by KS.A. 41-7109(b); AND, Retail Liquor Stores, Farm Wineries or Microbreweries premises must comply with the building regulations required by K.S.A. 41-710 located outside an incorporated city, in a township or county that is not zoned THE CITY/COUNTY ALLOWS: Basic Hours Expanded hours (Sunday sales) (Seal) Under penalties of perjury, I declare that the information contained in this document is a true, accurate and complete disclosure of information. CLERK SIGNATURE ______________________________________ PRINTED NAME_________________________________________ DATE_______________________________________ City Clerk Township Clerk ABC-802 (Rev. 7.1.12) American LegalNet, Inc. www.FormsWorkFlow.com County Clerk Clear Form