Form Abc-842 - Request To Participate In Special Event By Kansas Farm Winery, Microbrewery Or Microdistillery Licensees Page 2

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Kansas Department of Revenue
Alcoholic Beverage Control Division
915 S.W. Harrison Street
Topeka, KS 66625-3512
Phone: 785-296-7015 Fax: 785-296-7185
SECTION 3 – SPECIAL EVENT AREA DIAGRAM
Draw in the space below, in ink, a sketch of the area the special event will be held. The diagram must include the boundaries of the event
area.
Diagram:
I understand the approved request form must be displayed at the event; and, that no open containers
shall leave the event area.
_________________________________________
_________________________________________
Authorized Signature
Date
ABC OFFICE USE ONLY:
Signature of ABC Licensing Rep
Date
Is liquor by the drink allowed?
Yes
No
Tasting Only Event Request:
Approved
Denied
Are retail sales allowed?
Yes
No
Farm Winery Unopened Container Sales:
Approved
Denied
Licensee Notification:
Email
Fax
Mail
Request Scanned to Enforcement:
Yes
Entered in Tracking Log:
Yes
Clear Form
Page 2 of 2
ABC-842 (Rev. 4.2.13)

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