Form Ld-401 - Escrow Agreement For Guarantee Of Kansas Liquor Drink Tax Liability

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TOPEKA, KANSAS 66612-1588
Phone: (785) 368-8222
Fax: (785) 291-3968
This agreement entered into this ____________ day of ________________, _______, between _________________________
______________________________________, hereinafter referred to as the "Escrow Agent" and _____________________________
_______________________________________________________________________ hereinafter referred to as the "Depositor" is entered
(Underline one - Individual Proprietorship, Partnership, LLC or Corporation)
into to comply with the requirements of K.S.A. 79-41a03 as amended.
The Depositor agrees to purchase and deliver to the Escrow Agent a certificate of deposit issued by a Kansas bank, savings and loan
association, or credit union in the amount of $_______________, which amount the Depositor warrants is the amount established by the
Kansas Department of Revenue as the required bond. The Depositor may not assign, pledge as security for any loan, or otherwise encumber
the certificate during the period of this agreement.
For the privilege of operating a licensed establishment to sell alcoholic liquor in the State of Kansas, Depositor hereby grants the Kansas
Department of Revenue a security interest in the following described property: certificate of deposit number ________________________,
in the amount of $_______________, to be held in trust by the Escrow Agent for the Kansas Department of Revenue to secure the payment
of liquor drink tax pursuant to the Kansas Liquor Drink Tax Act.
The Escrow Agent hereby acknowledges receipt of notification of the Kansas Department of Revenue's security interest in the above
described property.
The Escrow Agent acknowledged receipt of the aforesaid certificate of deposit and will not return said certificate to the Depositor nor
allow said certificate to be assigned, pledged, or otherwise encumbered during the period of this agreement except as provided below. The
Escrow Agent shall remit interest on the certificate annually to the Depositor.
In the event Depositor defaults in payment of the Kansas Liquor Drink Tax obligations, the Escrow Agent, upon written demand from
Kansas Department of Revenue, shall remit the proceeds of the certificate of deposit and any interest accrued to date of notification to the
Kansas Department of Revenue or its authorized agent. Upon such remittance to the Kansas Department of Revenue, this agreement shall be
deemed terminated.
When the Director of Taxation of the State of Kansas determines that a bond is no longer required for the Depositor, notification in writing
shall be made to the Escrow Agent who will then be authorized to release the certificate of deposit to the Depositor and thus terminate this
Nothing in this agreement shall be so construed to increase the liability of the Escrow Agent beyond the amount and provisions of this
Dated at _____________________________________ this ____________ day of ___________________________, ________
Depositor's Signature
Escrow Agent's Signature
Depositor's Address
Liquor Drink Tax Reg. No.
Phone Number
State of
County of __________________________________________ ss
Subscribed and Sworn to before me this ____________ day of ____________________, _________.
Notary Public
My Commission Expires
(Rev. 6/13)


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