Form Abc-73 - Monthly Report Of On-Premise Sales Page 2

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KANSAS DEPARTMENT OF REVENUE
COMPLIANCE MANAGEMENT - AUDIT SERVICES
ATTN: LIQUOR AUDITING
915 S.W. HARRISON STREET
TOPEKA, KANSAS 66625-7719
Email: LiquorReport.Audit@kdor.ks.gov
MONTHLY REPORT OF ON-PREMISE SALES*
Report Period
Month:
Year:
Licensee Name
Kansas Liquor License No.
Business Mailing Address
Basic Wholesaler Permit No.
City
State
Zip Code
Person Completing Report
Telephone Number
I have no sales to report this month.
DATE OF
TOTAL SALE
LICENSEE NAME
ADDRESS AND CITY
LICENSE NUMBER
SALE
PRICE
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
TOTAL SALES $
I declare under penalties of perjury that to the best of my knowledge and belief this is a true, correct and complete form.
SIGNATURE ___________________________________________________TITLE__________________________________ DATE___________________
*On-premise sales includes sales to Class A Clubs, Class B Clubs, Drinking Establishments (including railway cars), Hotel/Drinking Establishments,
Caterers, Drinking Establishment/Caterer, Public Venue and Temporary Permit holders.
ABC-73 (Rev.7.1.12)

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