Form ABC-804 "Surety Bond for Liquor Licenses Issued Under the Liquor Control Act" - Kansas

What Is Form ABC-804?

This is a legal form that was released by the Kansas Department of Revenue - a government authority operating within Kansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the Kansas Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ABC-804 by clicking the link below or browse more documents and templates provided by the Kansas Department of Revenue.

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Download Form ABC-804 "Surety Bond for Liquor Licenses Issued Under the Liquor Control Act" - Kansas

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Alcoholic Beverage Control
Phone: 785-296-7015
109 SW 9
Street, 5
Floor
th
th
Fax: 785-296-7185
PO Box 3506
www.ksrevenue.org/abc.html
Topeka KS 66601-3506
SURETY BOND
FOR LIQUOR LICENSES ISSUED UNDER THE LIQUOR CONTROL ACT
Pursuant to K.S.A. 41-317
KNOW ALL MEN BY THESE PRESENTS:
That we
(Principal)
of the City of
, County of
, State of
as
Principal, and
,
a corporation organized and existing under and by
(Surety)
virtue of the laws of the State of
,
duly licensed to do business in the State of Kansas, as surety are held
and firmly bound unto the Director of the Alcoholic Beverage Control Division for and on behalf of the State of Kansas in the penal sum
of $
Dollars for the payment of which each of us, do bind ourselves, our heirs, executors, administrators,
successors and assigns, jointly and severally.
WHEREAS, the Principal has applied for or has been licensed by the Director of the Alcoholic Beverage Control Division of the State
of Kansas as a:
☐Beer Distributor
☐Spirits Distributor
☐Wine Distributor
☐Farm Winery
☐Retailer
☐Non-Beverage User
☐Special Order Shipping
☐Microbrewery
☐Microdistillery ☐Manufacturer
☐Producer
NOW, THEREFORE, if the said Principal shall faithfully comply with the provisions of the Kansas Liquor Control Act and the rules and
regulations of the Director of the Alcoholic Beverage Control Division in all respects, and shall promptly pay all fees, fines and taxes which
may be assessed, then this obligation shall be null and void, otherwise to remain in full force and effect. Such principle hereby authorizes
employees of the Kansas Department of Revenue to disclose to the surety herein a statement of account relating to the tax guaranteed
by this bond.
This bond shall be effective on and after the
day of
,
,
unless
(Day)
(Month)
(Year)
cancellation of such bond is approved by the Director of the Alcoholic Beverage Control Division, Department of Revenue, after having
been given thirty (30) day notice by the principal and surety.
Witness our hands at
,
,
this
day of
,
.
(City)
(State)
(Day)
(Month)
(Year)
SURETY COMPANY
(please print)
Signature of Attorney-in-Fact* for Surety Company:
Attorney-in-Fact Name:
Attorney-in-Fact Phone Number:
Surety Company Name:
Surety Company Mailing Address:
Surety Company Phone Number:
BOND NUMBER:
PRINCIPAL
(please print)
Signature of Principal or Agent:
Title:
Print Name of Signature Above:
Mailing Address:
Phone Number:
Check Entity Type:
Individual
Corporation
Partnership
LLC
LLP
Trust
Government
Other
ABC Office Use Only
☐Bond Released
License Number(s):
Rep’s Initials:
Date:
Rep’s Initials:
FEIN:
Date:
☐Bond Demand
Date:
Rep’s Initials:
ABC-804 (Rev. 05/19)
Alcoholic Beverage Control
Phone: 785-296-7015
109 SW 9
Street, 5
Floor
th
th
Fax: 785-296-7185
PO Box 3506
www.ksrevenue.org/abc.html
Topeka KS 66601-3506
SURETY BOND
FOR LIQUOR LICENSES ISSUED UNDER THE LIQUOR CONTROL ACT
Pursuant to K.S.A. 41-317
KNOW ALL MEN BY THESE PRESENTS:
That we
(Principal)
of the City of
, County of
, State of
as
Principal, and
,
a corporation organized and existing under and by
(Surety)
virtue of the laws of the State of
,
duly licensed to do business in the State of Kansas, as surety are held
and firmly bound unto the Director of the Alcoholic Beverage Control Division for and on behalf of the State of Kansas in the penal sum
of $
Dollars for the payment of which each of us, do bind ourselves, our heirs, executors, administrators,
successors and assigns, jointly and severally.
WHEREAS, the Principal has applied for or has been licensed by the Director of the Alcoholic Beverage Control Division of the State
of Kansas as a:
☐Beer Distributor
☐Spirits Distributor
☐Wine Distributor
☐Farm Winery
☐Retailer
☐Non-Beverage User
☐Special Order Shipping
☐Microbrewery
☐Microdistillery ☐Manufacturer
☐Producer
NOW, THEREFORE, if the said Principal shall faithfully comply with the provisions of the Kansas Liquor Control Act and the rules and
regulations of the Director of the Alcoholic Beverage Control Division in all respects, and shall promptly pay all fees, fines and taxes which
may be assessed, then this obligation shall be null and void, otherwise to remain in full force and effect. Such principle hereby authorizes
employees of the Kansas Department of Revenue to disclose to the surety herein a statement of account relating to the tax guaranteed
by this bond.
This bond shall be effective on and after the
day of
,
,
unless
(Day)
(Month)
(Year)
cancellation of such bond is approved by the Director of the Alcoholic Beverage Control Division, Department of Revenue, after having
been given thirty (30) day notice by the principal and surety.
Witness our hands at
,
,
this
day of
,
.
(City)
(State)
(Day)
(Month)
(Year)
SURETY COMPANY
(please print)
Signature of Attorney-in-Fact* for Surety Company:
Attorney-in-Fact Name:
Attorney-in-Fact Phone Number:
Surety Company Name:
Surety Company Mailing Address:
Surety Company Phone Number:
BOND NUMBER:
PRINCIPAL
(please print)
Signature of Principal or Agent:
Title:
Print Name of Signature Above:
Mailing Address:
Phone Number:
Check Entity Type:
Individual
Corporation
Partnership
LLC
LLP
Trust
Government
Other
ABC Office Use Only
☐Bond Released
License Number(s):
Rep’s Initials:
Date:
Rep’s Initials:
FEIN:
Date:
☐Bond Demand
Date:
Rep’s Initials:
ABC-804 (Rev. 05/19)