Form Abc-257 - Affidavit Of Kansas Farm Winery Regarding Compliance With Requirement To Use 30% Kansas Products Pursuant To Subsection (C) Of K.s.a. 41-308a

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Affidavit of Kansas Farm Winery Regarding Compliance with Requirement to Use
30% Kansas Products Pursuant to Subsection (c) of K.S.A. 41-308a
Applicant for Renewal License
STATE OF KANSAS
)
) SS:
COUNTY OF ________________________
)
The undersigned, a duly authorized representative of the Kansas Farm Winery indicated below,
being of lawful age and being first duly sworn, on his/her oath states that said Kansas Farm Winery is
renewing an existing license and that ________ percent of the agricultural products which it used in all of
the wine it produced during the past twelve months ending on __________________________ were
grown in Kansas.
If the percentage indicated above is less than 30%, then said Kansas Farm Winery must attach
to this affidavit a detailed plan as to how it intends to come into compliance with subsection (c) of K.S.A.
41-308a and requests approval of said plan from the Director.
Further affiant sayeth not.
_______________________________________
Signature of affiant
_______________________________________
Typed or printed name of affiant
_______________________________________
DBA Name of Kansas Farm Winery
_______________________________________
Kansas license number
SUBSCRIBED AND SWORN TO before me this __________________________ day of
_____________________________, 20_______.
_______________________________________
Notary Public
ABC-257 (Rev. 7.1.12)

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