Form Ld-401 - Escrow Agreement For Guarantee Of Kansas Liquor Drink Tax Liability Page 2
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2LD-401 Escrow Agreement for Guarantee of
Kansas Liquor Drink Tax Liability
(For Drinking Establishments, Class A Clubs, Class B Clubs,
Caterers, Public Venues, Hotels, or other On-Premise Licensees)
PLEASE READ BEFORE COMPLETING THIS BOND FORM!
Bond Instructions:
™ You must complete the most current version of Form LD-401, Escrow Agreement for Guarantee
of Kansas Liquor Drink Tax Liability. The most current version can be found on our web site:
™ All fields on this form must be completed, except for the Liquor Drink Tax Reg. No. field.
™ Line 1 of the bond must contain the date coverage begins under this bond.
™ “Escrow Agent” must be a Kansas financial institution.
™ “Depositor” must be the legal name of the entity applying for or holding a Kansas liquor license
and must match exactly the entity name listed on the liquor tax application.
For a sole
proprietorship, this must be the individual’s name. For general partnerships, each partner must
be listed.
™ The amount of the bond cannot include funds from another active liquor escrow bond.
™ The Depositor must sign the bond and provide a mailing address.
™ The Escrow Agent must sign the bond and provide a mailing address and telephone number.
™ The escrow bond agreement must be notarized. A notary cannot notarize their own signature!
™ The certificate of deposit being held in escrow cannot be released, transferred, assigned,
pledged, rolled into another certificate of deposit, or otherwise encumbered until released or
demanded by the Department of Revenue.
™ Failure to complete the LD-401 properly will result in an invalid bond. The bond will be voided
and kept in the customers file.
™ Original bonds cannot be returned.
™ Questions regarding this form should be directed to the Division of Taxation, Miscellaneous Tax
Segment, at (785) 368-8222, option 5, then option 4.
™ Submit this form to:
Miscellaneous Tax
Kansas Department of Revenue
915 SW Harrison St.
Topeka, KS 66612-1588
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