Form Abc-1010 - Kansas Farm Winery - Instructions And Application For Brand Registration And Label Approval Page 4
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5Kansas Department of Revenue
Alcoholic Beverage Control Division
915 S.W. Harrison Street, Room 214
Topeka, KS 66625-3512
Phone: 785-296-7015 Fax: 785-296-7185
KANSAS FARM WINERY
APPLICATION FOR BRAND REGISTRATION AND LABEL APPROVAL
SECTION 1 – LICENSEE INFORMATION
Farm Winery DBA Name
License No.
Business Mailing Address
City
State
Zip Code
Contact Person
Title of Contact Person
Telephone Number
FAX Number
E-Mail Address
SECTION 2 – TRANSACTION REQUESTED*
New Brand Registration and New Label Approval
New Label Approval Request
Seasonal or Promotional Package Approval Request
Effective From :_______________ Effective To: ________________
Label Revision Request
Inactivate Label(s)
Cancel Brand and all Labels
Other__________________________________
TOTAL LABEL APPROVALS REQUESTED __________
* SUBMIT ONLY ONE TRANSACTION TYPE PER FORM
FOR DEPARTMENT USE ONLY
Number of Labels Approved:
Number of Labels Denied:
Reason:
Signed:
Date:
ABC-1010 (Rev. 7.1.11)
Page 4 of 5
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