Form Bi-160 - Renewal Application For Bingo License (Page 3 of 3) in pdf

Form Bi-160 - Renewal Application For Bingo License Page 3

STATE OF KANSAS

DEPARTMENT OF REVENUE

Customer Relations, Bingo Licensee Segment

Toll Free 1-877-526-7738

Kansas Department of Revenue

Phone: (785) 368-8222

915 SW Harrison St.

Fax: (785) 296-2073

Topeka, KS 66625-0001

Hearing Impaired TTY: (785) 296-6461

Division of Taxation

INSTRUCTIONS FOR RENEWAL OF BINGO LICENSE

Enclosed is an application to renew your organization’s Bingo License for the upcoming license year starting

July 1. Your current bingo license expires on June 30 of this year. The application for renewal should be

completed and mailed back to us no later than June 1 to assure that we can process it and mail out your new

certificate before July 1. It is unlawful to conduct bingo games without a current bingo license on display.

Your renewal application must be accompanied by a check for the license fee of $25 made payable to the

Kansas Department of Revenue. Please do not send cash.

Please be sure that the Verification at the end of the renewal application is fully completed. It requires the

signature of the presiding officer of your organization and the secretary, or equivalent. The person in charge of

your bingo operations should not sign the Verification unless that person also happens to be the presiding

officer of your organization. Be sure to have the Verification properly notarized by a Kansas Notary Public.

If you have questions regarding renewal of your bingo license or you need additional information, please call

the Bingo Administrator at 785-296-6127.

DISCONTINUATION OF BUSINESS

To cancel your certificate, sign below and indicate the date the business ceased to operate under this ownership.

Mail this entire document to Bingo Licensing Segment, Customer Relations, Kansas Department of Revenue,

915 SW Harrison St, Topeka, KS 66625-0001. If you have any questions please call our office at (785) 368-

8222 or toll free outside Topeka at 1-877-526-7738.

Date business ceased to operate under this ownership:

Signature of Owner, Partner, or Principal Corporate Officer

Date

Form Bi-160 - Renewal Application For Bingo License Page 3