Form ABC-1003 Kansas Suppliers' Monthly Report of Shipments to Kansas Distributors - Kansas

Form abc-1003 or the "Kansas Suppliers' Monthly Report Of Shipments To Kansas Distributors" is a form issued by the kansas Department of Revenue.

Download a PDF version of the Form abc-1003 down below or find it on the kansas Department of Revenue Forms website.

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Kansas 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 SUPPLIERS’ MONTHLY REPORT OF SHIPMENTS TO KANSAS DISTRIBUTORS
REPORT PERIOD
Month:
Year:
Supplier Name
Kansas Supplier Permit No.
19 - 00 ___ - ___ ___ ___ ___ - ___ ___
Business Mailing Address
City
State
Zip Code
Person Completing Report
E-Mail Address
Telephone Number
FAX Number
I do not have any shipments to report this month.
Spreadsheet attached
PURCHASE
DISTRIBUTOR
PURCHASE
DISTRIBUTOR
SHIPMENT DATE
SHIPMENT DATE
ORDER NUMBER
NAME
ORDER NUMBER
NAME
th
This report must be filed by the 15
day of the following month. You are required to file this report even
if you have no shipments to report.
All records shall be maintained for three years and shall be available for inspection by the Director or
any agent or employee of the Director or Secretary upon request. DO NOT SEND INVOICES.
I declare under penalties of perjury that to the best of my knowledge and belief this is a true, correct and complete return.
SIGNATURE ____________________________________________ TITLE ______________________________________________________________
State whether individual owner, member of firm, or title if officer of corporation.
DATE __________________________________________________
ABC-1003 (Rev. 7.1.11)
Kansas 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 SUPPLIERS’ MONTHLY REPORT OF SHIPMENTS TO KANSAS DISTRIBUTORS
REPORT PERIOD
Month:
Year:
Supplier Name
Kansas Supplier Permit No.
19 - 00 ___ - ___ ___ ___ ___ - ___ ___
Business Mailing Address
City
State
Zip Code
Person Completing Report
E-Mail Address
Telephone Number
FAX Number
I do not have any shipments to report this month.
Spreadsheet attached
PURCHASE
DISTRIBUTOR
PURCHASE
DISTRIBUTOR
SHIPMENT DATE
SHIPMENT DATE
ORDER NUMBER
NAME
ORDER NUMBER
NAME
th
This report must be filed by the 15
day of the following month. You are required to file this report even
if you have no shipments to report.
All records shall be maintained for three years and shall be available for inspection by the Director or
any agent or employee of the Director or Secretary upon request. DO NOT SEND INVOICES.
I declare under penalties of perjury that to the best of my knowledge and belief this is a true, correct and complete return.
SIGNATURE ____________________________________________ TITLE ______________________________________________________________
State whether individual owner, member of firm, or title if officer of corporation.
DATE __________________________________________________
ABC-1003 (Rev. 7.1.11)

Download Form ABC-1003 Kansas Suppliers' Monthly Report of Shipments to Kansas Distributors - Kansas

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