PARTNERSHIP, FIRM OR ASSOCIATION
APPLICATION FOR LICENSE TO SELL CEREAL MALT BEVERAGES
(This form has been prepared by the Attorney General’s Office)
City or
County of ______________________________________________________________________
SECTION 1 – LICENSE TYPE
Check One:
New License
Renew License
Special Event Permit
Check One:
License to sell cereal malt beverages for consumption on the premises.
License to sell cereal malt beverages in original and unopened containers and not for consumption on the licensed premises.
SECTION 2 – APPLICANT INFORMATION
Kansas Sales Tax Registration Number (required):
Name of Partnership/Firm/Association
Phone No.
Place of Business Street Address
City
Zip Code
SECTION 3 – LICENSED PREMISE
Licensed Premise
Mailing Address
(Business Location or Location of Special Event)
(If different from business address)
DBA Name
Name
Business Location Address
Address
City
State
Zip
City
State
Zip
Business Phone No.
I own the proposed business location.
I do not own the proposed business location.
Business Location Owner Name(s)
SECTION 4 – PARTNER AND FIRM/ASSOCIATION MEMBER INFORMATION
List each partner or member of a firm/association and their spouse, if applicable. Attach additional pages if necessary.
Partner/Member Name
Title
Date of Birth
Residence Street Address
City
State
Zip Code
Spouse Name
Title
Date of Birth
Residence Street Address
City
State
Zip Code
Partner/Member Name
Title
Date of Birth
Residence Street Address
City
State
Zip Code
Spouse Name
Title
Date of Birth
Residence Street Address
City
State
Zip Code
Partner/Member Name
Title
Date of Birth
Residence Street Address
City
State
Zip Code
Spouse Name
Title
Date of Birth
Residence Street Address
City
State
Zip Code
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AG CMB Partnership, Firm or Association Application (Rev. 07.08.2013)