Form Abc-827 - Request To Extend License Term

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Kansas 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
REQUEST TO EXTEND LICENSE TERM
Effective July 1, 2010, the director may, at the director’s sole discretion and after examination of the circumstances,
1
extend the license term of any license for not more than 30 days beyond the date such license would expire.
Any extension of the license term by the director shall automatically extend the due date for payment by the licensee
of any occupation or license tax levied by a city or township by the same number of days the director has extended
the license term.
Licensee Information:
Licensee Name
License Number
Address
City
State
Zip Code
Phone Number
Fax Number
Email Address
Circumstances of Request:
Death
Fire
Natural disaster (flood, tornado, etc.)
Serious illness or injury resulting in hospitalization
Other – Explain:___________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
2
I have attached the documentation supporting my request for a license term extension.
Under penalties of perjury, I declare the information contained in this document a true, accurate and
complete disclosure of information.
Licensee Signature
Date
Printed Name
Title
1
A request for extension does not constitute the ability to operate without a liquor license. Determination of your request will be made and you will
be notified of the decision within 5 calendar days from the receipt of your request. In the event your request is approved, you will be provided with
a license extension. If your request is denied, you must cease the sale of all alcoholic liquor immediately upon expiration of your liquor license.
2
Documentation supporting the circumstances of your request must be attached to this form.
ABC Office Use Only
Signature of ABC Director
Date
APPROVED – Days extended:______
Date Notified:_____________ By:________
DENIED
Method:
E-mail
Fax
Mail
ABC-827 (Rev. 7.1.11)
Clear Form

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