Form Abc-835 - Non-Beverage Permit Application And Agreement Page 2
Download a blank fillable Form Abc-835 - Non-Beverage Permit Application And Agreement in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Abc-835 - Non-Beverage Permit Application And Agreement with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Kansas 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
NON-BEVERAGE PERMIT APPLICATION AND AGREEMENT
APPLICANT TYPE (check one):
College
Hospital
Sanatorium
School
Other institution caring for the sick
SECTION 1 – APPLICANT INFORMATION:
Applicant DBA Name
Phone
Fax
Street Address
City
County
Zip Code
Contact Person
Email Address
Mailing Address
(Complete if different than above).
Name
Address
City
Zip Code
SECTION 2 – PURCHASE INFORMATION:
Purpose
Scientific
Chemical
Experimental
Mechanical
Medicinal
(check one):
I/We intend to purchase from a
(check one):
Distributor
Farm Winery
Manufacturer
Microbrewery
Microdistillery
The above Distributor, Farm Winery, Manufacturer, Microbrewery or Microdistillery is located
(check one):
In-state
Out-of-state
Location where alcohol or wine will be stored:
The above named school, college, hospital, sanatorium or institution caring for the sick, does hereby make
application for a Non-Beverage User permit to purchase alcohol or wine. In making this application, the above
named Non-Beverage Permit applicant agrees that they will:
a. Make a one-time purchase of alcohol or wine only for scientific, chemical, experimental, mechanical or medicinal
purposes.
b. Forward two copies of their Non-Beverage permit to the microbrewery, farm winery, manufacturer or distributor
from whom they are purchasing alcohol or wine.
c. Not use, serve or sell the alcohol or wine that is purchased under this permit for human consumption.
d. Attach the invoice to their permit and return it to the ABC within 10 days of receipt of alcohol or wine.
e. Comply with applicable city and county laws; and, with all the provisions of the Kansas Liquor Control Act, Club
and Drinking Establishment Act and the Rules and Regulations promulgated thereunder.
f.
Authorize KDOR to send communications to the e-mail address provided on this form.
________________________________________
____________________________________
Authorized Signature
Date
________________________________________
____________________________________
Printed Name
Title
ABC Office Use Only:
PERMIT FEE ENCLOSED Amount $_________ Associate: ___________________________ Date_________________________________
APPROVED Date:_________________________ Associate: ___________________________ Permit #______________________________
DENIED Date_____________________________ Associate:___________________________
Denial Letter Sent Date_______________
ABC-835 (Rev. 7.1.12)
Page 2 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Abc-1010 - Kansas Farm Winery - Instructions And Application For Brand Registration And Label Approval
Financial
Form Bt-100 - Alcoholic Beverage Tax - Application For Permission To Import Into Connecticut Alcoholic Beverages
Financial
Related Categories
Parent category: Financial