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Registration Of Delivery Vehicles ABC-103-R - Kansas
| Registration Of Delivery Vehicles Form. This is a Kansas form and can be used in Liquor License Forms And Registration Alcohol Beverage Control Statewide . |
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DEPARTMENT OF REVENUE Licensee Segment 915 SW Harrison St. Topeka, KS 66625-2073 Internet Address: www.ksrevenue.org STATE OF KANSAS Phone: (785) 368-8222 Toll Free: 1-877-526-7738 FAX: (785) 296-2073 Hearing Impaired TTY: (785) 296-6461 Alcoholic Beverage Control REGISTRATION OF DELIVERY VEHICLES Retail Liquor Licensee For the purpose of qualifying to carry liquor in vehicle(s) listed below, and issuance of a vehicle identification card the licensee certifies and warrants that the statements and representations made herein are true and correct. If any statement or representations are herein found to be false, the director may refuse to issue a vehicle identification card or may cause the card to be relinquished at any time. 1. Name of Store: 2. Retail Liquor License Number: __ __ / __ __ __ / __ __ __ __ / __ __ 3. Store Address: __________________________________________________________________ Street City State Zip 4. List all vehicles which will be used to transport alcoholic liquor: Make ________________ ________________ ________________ ________________ ________________ Year ______________ ______________ ______________ ______________ ______________ Vehicle I.D. # ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ I agree, if issued vehicle identification cards, to abide by the provisions of the Kansas Liquor Control Act and the rules and regulations thereunder in the transportation of alcoholic liquor in Kansas. Licensee Signature Date Phone Number ABC 103-R (Rev. 2/02) American LegalNet, Inc. www.FormsWorkflow.com
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