Form Abc-809 - Notice Of Ownership Change
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2Kansas Department of Revenue
Alcoholic Beverage Control Division
915 S.W. Harrison Street, Room 214
Topeka, KS 66625-3512
Phone: 785-296-7015 Fax: 866-855-5025
NOTICE OF OWNERSHIP CHANGE
All entity types, except Class A Clubs and Individuals, must complete and submit this form when there are any changes in the
ownership and your FEIN remains the same. If your FEIN will change, you must complete and submit the ABC-800 Application for
Liquor License.
SECTION 1 – LICENSEE INFORMATION
FEIN _____________________
Licensee DBA Name
License Number
Location Street Address
City
County
Zip Code
The following information must be provided on the applicant(s); partners; all officers and directors (if a corporation or LLC); and
anyone with a financial interest,
AND the spouses of all submitted
persons. (Attach additional pages as necessary). The
percentage(s) of ownership must total 100%.
SECTION 2 – NEW OWNERSHIP INFORMATION
Last Name
First Name
Middle Name
Gender
Date of Birth
Birthplace
Other Names Used
Maiden Name
Social Security No.
Driver’s License No.
State
% Ownership
Position
Marital Status
Address
City
State
County
Zip Code
Daytime Phone
Last Name
First Name
Middle Name
Gender
Date of Birth
Birthplace
Other Names Used
Maiden Name
Social Security No.
Driver’s License No.
State
% Ownership
Position
Marital Status
Address
City
State
County
Zip Code
Daytime Phone
Last Name
First Name
Middle Name
Gender
Date of Birth
Birthplace
Other Names Used
Maiden Name
Social Security No.
Driver’s License No.
State
% Ownership
Position
Marital Status
Address
City
State
County
Zip Code
Daytime Phone
Last Name
First Name
Middle Name
Gender
Date of Birth
Birthplace
Other Names Used
Maiden Name
Social Security No.
Driver’s License No.
State
% Ownership
Position
Marital Status
Address
City
State
County
Zip Code
Daytime Phone
Last Name
First Name
Middle Name
Gender
Date of Birth
Birthplace
Other Names Used
Maiden Name
Social Security No.
Driver’s License No.
State
% Ownership
Position
Marital Status
Address
City
State
County
Zip Code
Daytime Phone
ABC-809 (Rev. 7.1.11)
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