Form Abc-22 - Abc Liquor License/permit Business Name And/or Address Change Form
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1Kansas 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
ABC LIQUOR LICENSE/PERMIT BUSINESS NAME AND/OR ADDRESS CHANGE FORM
Business Name
License Number
I am changing my Business Name to:
I am changing my DBA Name to:
I am changing my:
Business Mailing Address
Business Location Address
NEW BUSINESS MAILING ADDRESS
Street
County
City
State
Zip
Phone Number
Email Address
BUSINESS LOCATION ADDRESS
ABC-806 Premise Approval attached
Lease/Deed attached
Current Location Address
Street
County
City
State
Zip
New Location Address
Street
County
City
State
Zip
Phone Number
Email Address
Effective Date
Inside City Limits
Outside City Limits
This change will affect the following license/permit type(s):
Retailer
Beer Distributor
Warehouse
Class A Club
Spirits Distributor
Beer Manufacturer
Class B Club
Wine Distributor
Spirits Manufacturer
Drinking Establishment
Supplier Permit
Wine Manufacturer
Hotel / Drinking Establishment
Microbrewery
Farm Winery
Caterer
Microbrewery Packaging and
Farm Winery Outlet
Drinking Establishment / Caterer
Warehousing Facility
Farm Winery / Caterer
Hotel / Caterer
Non-Beverage User
Special Order Shipping
Public Venue
Microdistillery
Microdistillery Packaging and
Warehousing Facility
Signature
Date
Return your completed form to the above address.
Office Use Only
BUSINESS NAME CHANGE:
Signature of ABC Licensing Customer Rep
Date
Checked DBAs
Approved
Denied
Reason Denied:
MAILING ADDRESS:
Approved
Denied
Signature of ABC Licensing Customer Rep
Date
Reason Denied:
LOCATION CHANGE:
Approved
Denied
Signature of ABC Director
Date
Reason Denied:
Clear Form
ABC-22 (Rev. 7.30.13)
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Parent category: Financial