Form Abc-172 - Request To Transfer Keg Tags printable pdf download

Form Abc-172 - Request To Transfer Keg Tags

Kansas Department of Revenue

Alcoholic Beverage Control Division

915 S.W. Harrison Street, Room 214

Topeka, KS 66625-3512

Phone: 785-296-7015 Fax: 785-296-7185

REQUEST TO TRANSFER KEG TAGS

This request must be submitted AND approved prior to transfer of keg tags. Transfers of keg tags will

only be authorized between a licensee who is selling a business to another licensee who will be operating at

that same location or for emergency circumstances. If the transfer is not authorized, all keg tags must be

returned to the ABC at the address listed above before the date of the sale of the business.

Check one: Request Type:

Ownership Transfer

Emergency Transfer

Transferring Owner Information:

Owner Name:

DBA Name:

License Number / CMB Stamp Number / ATF Number:

Address:

City / State / Zip:

Phone:

Fax:

Keg Tag Transfer Request:

I request permission to transfer the following keg tags to the licensee below:

Tag Number(s):____________________________________________________________ Quantity:______________

Signature of Transferring Owner:_____________________________________________ Date:_________________

Receiving Owner Information:

Owner Name:

DBA Name:

License Number / CMB Stamp Number / ATF Number:

Address:

City / State / Zip:

Phone:

Fax:

ABC Office Use Only:

Approved By:

Date:

Denied By:

Date:

ABC-172 (Rev. 7.1.11)

Form Abc-172 - Request To Transfer Keg Tags