Instructions For Ownership Disclosure Form Abc-280od printable pdf download

Kansas Department of Revenue

Alcoholic Beverage Control

Instructions for

OWNERSHIP DISCLOSURE FORM ABC-280OD

READ CAREFULLY

The information required on this is pursuant to K.S.A. 41-311, K.S.A. 41-901, and K.S.A. 41-2623. Fill out all appropriate boxes.

Failure to provide all the required information will result in a delay in processing your applications.

Please check new or renewal.

Section 1

Check the appropriate box for the type of business that applies.

Types of business:

Individual – A business owned directly by one person.

Corporation – A business with Articles of Incorporation on file with the Secretary of State of Kansas.

Partnership/Limited Partnership/Limited Liability Company

Partnership – A business owned by two or more individuals or entities with a bona fide partnership

agreement.

Limited Partnership – A business owned by two or more individuals or entities with a bona fide

Limited Partnership Agreement on file with the Secretary of State of Kansas.

Limited Liability Company – A business owned by two or more individuals or entities with a bona fide Limited Liability

Company Agreement on file with the Secretary of State of Kansas.

Check the appropriate box for the type of license you are applying for. Complete the name and address of the business. Fill

in the license number if completing a renewal application. Provide the Federal Employee Identification Number.

Section 2

The following information must be provided for all individual owners and partners: corporate officers, corporate managers, directors and

stockholders, grantors, trustees and beneficiaries of a trust. The information on the spouse of each individual is also required. Any

individual owning interest must indicate the percent owned.

*Please note that this form is only to be used for the above listed persons. Any employees (waiters, waitresses, bartenders, servers,

clerks), club managers, bar managers, store managers, etc. should be listed on the Employees Registrations Form ABC-280-6 or ABC-

280-6s and should not be listed on the Ownership Disclosure Form.

The personal data required is necessary to insure a complete and accurate identification for investigative purposes. Applicants must

provide a full legal name. Use additional copies of this form if necessary. The personal oath on the reverse of this form must be

completed on this and any additional copies submitted.

Section 3

The following questions apply to all individual owners and partners: corporate officers, corporate managers, directors and stockholders,

grantors, trustees and beneficiaries of a trust; and the spouse of each individual. If the answer to any question is “Yes” a written

explanation must be submitted with this form. This information is required to insure that applicants meet the qualifications to hold a

license.

Section 4 – (Does not apply to individual type businesses)

Completion of this section will satisfy the requirements of K.S.A. 41-313 and K.S.A. 41-2625.

Corporation, Limited Partnership, Limited Liability Company: A process agent, a KANSAS RESIDENT, must be

appointed and maintained at all times by all corporations for the purposes of service of process, authority and

responsibility for the conduct of all business within the state relative to the license. Such agent shall be required to have

all the qualifications required of a licensee and completion of Section 5 will serve as duly authenticated power of

attorney. The agent shall be subject to the approval of the Director with respect to the agent’s character.

Section 5

Applicant oath must be signed by the applicant or authorized agent and notarized in order to process the application. Completion of the

oath will satisfy the power of attorney requirement referred to in Section 4.

Section 6

Applicant must specify one of the persons listed in Section 2 to be the designated contact person to handle all necessary communications

regarding the processing of the application for a liquor license.

ABC-280-OD (Rev. 12/99)

Instructions For Ownership Disclosure Form Abc-280od

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