Form Abc 216 - Alcoholic Beverage Control Gallonage Tax Remittance Voucher

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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: 785-296-7185
ALCOHOLIC BEVERAGE CONTROL
GALLONAGE TAX REMITTANCE VOUCHER
Distributors’
EDI and Web Filers
MONTH:_______________ YEAR: __________ FEIN: ___ ___ - ___ ___ ___ ___ ___ ___ ___
TODAY’S DATE: _____________________________________________________________________
DISTRIBUTOR NAME: ________________________________________________________________
LICENSE NUMBER: __________________________________________________________________
CONTACT PERSON: _________________________________________________________________
EMAIL ADDRESS: ___________________________________________________________________
I have filed my Liquor Enforcement Tax Return electronically.
GALLONAGE TAX PAYMENT DISTRIBUTION
DEPOSIT CODE:
TAX AMOUNT DUE:
PRODUCT TYPE:
Alcohol and Spirits
(GLAS)
$
Fortified Wine
(FWGL)
$
Light Wine
(LWGL)
$
Beer
(GLBR)
$
Cereal Malt Beverage
(MBTX)
$
Flavored Malt Beverage –
( GFMB)
Strong
$
Flavored Malt Beverage –
(FMBT)
Weak
$
$
TOTAL REMITTANCE =
ABC 216 (Rev 7.1.11)

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