Form Abc-190 - Notification Of Industry Seminar
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1Kansas Department of Revenue
Alcoholic Beverage Control Division
915 SW Harrison Street
Topeka, KS 66625-3512
Phone: 785-296-7015 Fax: 866-855-5025
NOTIFICATION OF INDUSTRY SEMINAR
Submit your completed form to the address or fax number above at least seven (7) days prior to the event.
Distributor Information:
Distributor Name
License Number(s)
Phone Number
Contact Person Name
Seminar Information:
This seminar is for the following licensees and their employees: (check all that apply)
Retailers
Clubs
Drinking Establishments
Caterers
Hotel Drinking Establishments
Date:
From Time:
To Time:
Location Address:
Additional Information:
Pursuant to K.S.A 41-709 and K.A.R. 14-14-6(a), by submitting this notice we acknowledge that:
1. liquor enforcement taxes, based on the current posted prices of the products, must be remitted on any
alcoholic beverages removed from our inventory for this seminar,
2. the seminar is conducted solely for product information and marketing purposes,
3. any alcoholic beverage samples will be consumed only on the seminar premises and in accordance with
Kansas law; and,
4. the alcoholic liquor and/or cereal malt beverage samples provided at this seminar are for licensees and their
employees.
Under penalties of perjury, I declare the information contained in this document a true, accurate and
complete disclosure of information.
________________________________________
________________________________________
Authorized Signature
Date
________________________________________
________________________________________
Printed Name
Printed Title
ABC Office Use Only
Signature of ABC Official
Date
Notified Licensee via:
Email
Fax
Mail
Notified Enforcement via email:
Yes
ABC-190 (Rev. 10.5.12)
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