Form LD-400 "Liquor Drink Tax Surety Bond" - Kansas

What Is Form LD-400?

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 August 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 LD-400 by clicking the link below or browse more documents and templates provided by the Kansas Department of Revenue.

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Download Form LD-400 "Liquor Drink Tax Surety Bond" - Kansas

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493118
KANSAS DEPARTMENT OF REVENUE
LIQUOR DRINK TAX SURETY BOND
Bond No.:
Liquor Drink
Reg. No.:
KNOW ALL MEN BY THESE PRESENTS:
That we
,
(Underline one entity type– Individual Proprietorship, Partnership, LLC or Corporation)
with main office location at
,
(Street Address)
(City)
(State)
(Zip)
as Principal, and the
,
a corporation authorized to transact business in Kansas, as
(Surety)
surety, are held and firmly bound unto the STATE OF KANSAS in the sum of
dollars
($
), lawful money of the United States, to the payment of which, well and truly to be made, we hereby
bind ourselves, our heirs, executors, administrators, assigns, and successors firmly by these presents.
WHEREAS, the above-named principal has made application to the Director of Taxation for a Liquor Drink Tax Certificate of
Registration to operate a licensed establishment selling alcoholic liquor at
(Street)
,
Kansas, and is subject to the Kansas Liquor Drink Tax Act:
(City)
NOW, THEREFORE, the condition of this obligation is such that if the above-named principal shall well and faithfully comply
with all of the provisions of the Kansas Liquor Drink Tax Laws, Rules and Regulations relating to the payments of liquor drink tax
and penalty due under the laws of this State of Kansas, then this obligation shall be void and of no effect; otherwise it shall be and
remain in full force and effect. Such principal 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 obligation shall be a continuing obligation and shall remain in full force and effect until canceled by the principal and
surety after having given thirty (30) days written notice to the obligee at the address above.
This bond is effective on and after the
day o
f
,
Witness our hands at
,
Kansas, this
day of
,
(Year)
(Principal)
By
(Indicate position:
President
Vice President
Partner
Owner
)
SEAL
(Print Name of Signature Above)
(Surety)
(Surety Address)
(Surety Company Phone Number)
By
(Surety Signature)
Its
(Bond shall be accompanied by power of attorney for attorney-in-fact. A Kansas licensed
agent of the surety must countersign.)
LD-400 (Rev.8-19)
(Kansas Licensed Agent Signature - must sign)
493118
KANSAS DEPARTMENT OF REVENUE
LIQUOR DRINK TAX SURETY BOND
Bond No.:
Liquor Drink
Reg. No.:
KNOW ALL MEN BY THESE PRESENTS:
That we
,
(Underline one entity type– Individual Proprietorship, Partnership, LLC or Corporation)
with main office location at
,
(Street Address)
(City)
(State)
(Zip)
as Principal, and the
,
a corporation authorized to transact business in Kansas, as
(Surety)
surety, are held and firmly bound unto the STATE OF KANSAS in the sum of
dollars
($
), lawful money of the United States, to the payment of which, well and truly to be made, we hereby
bind ourselves, our heirs, executors, administrators, assigns, and successors firmly by these presents.
WHEREAS, the above-named principal has made application to the Director of Taxation for a Liquor Drink Tax Certificate of
Registration to operate a licensed establishment selling alcoholic liquor at
(Street)
,
Kansas, and is subject to the Kansas Liquor Drink Tax Act:
(City)
NOW, THEREFORE, the condition of this obligation is such that if the above-named principal shall well and faithfully comply
with all of the provisions of the Kansas Liquor Drink Tax Laws, Rules and Regulations relating to the payments of liquor drink tax
and penalty due under the laws of this State of Kansas, then this obligation shall be void and of no effect; otherwise it shall be and
remain in full force and effect. Such principal 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 obligation shall be a continuing obligation and shall remain in full force and effect until canceled by the principal and
surety after having given thirty (30) days written notice to the obligee at the address above.
This bond is effective on and after the
day o
f
,
Witness our hands at
,
Kansas, this
day of
,
(Year)
(Principal)
By
(Indicate position:
President
Vice President
Partner
Owner
)
SEAL
(Print Name of Signature Above)
(Surety)
(Surety Address)
(Surety Company Phone Number)
By
(Surety Signature)
Its
(Bond shall be accompanied by power of attorney for attorney-in-fact. A Kansas licensed
agent of the surety must countersign.)
LD-400 (Rev.8-19)
(Kansas Licensed Agent Signature - must sign)
LD-400 Liquor Drink Tax Surety Bond Instructions
(For Drinking Establishments, Class A Clubs, Class B Clubs, Caterers,
Public Venues, Hotels, or other On-Premise Licensees)
PLEASE READ BEFORE COMPLETING THIS BOND FORM
You must complete the most current version of Form LD-400, Liquor Drink Surety Bond. The most
current form can be found on our website: www.ksrevenue.org
All fields on this form must be completed, except for the Liquor Drink Reg. No. field.
This bond must contain a bond number.
Line 1 of the bond must contain the legal name of the entity applying for or holding a Kansas liquor
license and must match exactly the entity name listed on the liquor tax application.
The location address on this bond must match exactly the location address on the liquor application.
This cannot be a PO Box.
The effective date is the date liquor drink tax coverage under this surety bond begins.
Signature lines:
“Principal” is the entity being covered under this surety bond.
o
An owner or officer must sign this bond and mark the box indicating their position.
o
The owner/officer must print their name below the signature line.
o
“Surety” is the name of the surety company providing the bond coverage.
o
A complete mailing address of the surety company must be provided, along with a telephone
o
number.
A signature of an authorized attorney-in-fact is required. The bond must be accompanied by a
o
power of attorney for the attorney-in-fact. A Kansas licensed agent of the surety must countersign.
The bond and power-of-attorney form must contain a seal.
o
Failure to complete the LD-400 properly will result in an invalid bond. The bond will be voided and kept
in the customer’s file.
Original bonds cannot be returned.
If you need any additional copies you can find them at: http://ksrevenue.org/bustaxtypescig.html or
have questions regarding this form should be directed to the Division of Taxation, Miscellaneous Tax
Segment, at 785-368-8222, option 5, then option 4, then option 2 or they can be faxed to 785-296-
4993.
Submit this form to:
Miscellaneous Tax
Kansas Department of Revenue
PO Box 3506
Topeka, KS 66625-3506
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