Form Abc-865 - Notification Of Non-Profit Organization Event Promoting The Arts
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1Kansas 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
NOTIFICATION OF NON-PROFIT ORGANIZATION
EVENT PROMOTING THE ARTS
Who must complete this form?
A non-profit organization that wishes to sponsor an event promoting the arts must complete this form if
non-licensed businesses wish to serve free alcoholic liquor or Cereal Malt Beverages to members of the
general public during the event. Notification must be received by the Director at least ten (10) days
prior to the event.
The local governing body must approve the event by ordinance or resolution, which much be submitted
with this form.
Complete this form and return to the address or fax number above at least ten (10) days prior to the
event.
Non-Profit Organization Information:
Organization Name
Organization Mailing Address
City
County
Zip
Contact Person Name
Email Address
Phone Number
Fax Number
Event Information:
Title of Event
Date(s) of Event
Beginning Time of Event
Ending Time of Event
Address
City
County
Zip Code
I have attached a copy of the required ordinance or resolution authorizing this event.
I have attached a list of participating businesses.
_______________________________________
_________________________________________
Authorized Signature
Date
FOR OFFICE USE ONLY:
Received less than 10 days prior to event.
Scanned to Enforcement Agent
Date: ________________________
Associate: _______________________
ABC-865 (7.1.13)
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Parent category: Financial