Temporary Extension Request - LibraryAlcoholic Beverage Control
109 SW 9th Street, 5th Floor
PO Box 3506
Topeka KS 66601-3506 Department of Revenue
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Phone: 785-296-7015
Fax: 785-296-7185
Kdor _abc.email@ks.gov
www.ksrevenue.gov/abc.html
REQUEST FOR TEMPORARY EXTENSION OF PREMISE APPROVAL
Licensee Information
Business OBA Name License Number J~\ew; ~ t-.~-...... ~~~+6~
Business Location S reet Address Zip Code
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Phone Number Email Address
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Event Start Time(s)
Temporary Extension Information
Check all that apply:
B' I am extending onto unlicensed or unpermtted premises
}ijves Is the area of the extension under the control of the licensee? O No
I have attached written permission from the owner or city/county. lMYes ONo
Ga I am extending onto a temporarily permitted premises. ,.i ~
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What is the event name? .J>&-t Sao Cbc-a Uq. \-1' O{) 0. c-'\:L(
I am extending onto any of the following areas: public streets, alleys, roads, sidewalks or highways.
D I have attached the ordinance or resolution approved by the local governing body., OYes ONo
Diagram: Draw a complete diagram of the premises for which you are seeking approval or attach your drawing. The
diagram must indicate the current premise and the temporary extension area. Architectural drawings will not be accepted.
Check one: B Diagram drawn below D 81h" X 11 " drawing attached on supplimental page
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ABC-816 (Rev. 07/19)
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Alcoholic Beverage Control
109 SW 9th Street, 5th Floor
PO Box 3506
Topeka KS 66601-3506
Phone: 785-296-7015
Fax: 785-296-7185
Kdor_abc.email@ks.gov
www.ksrevenue.gov/abc.html
Zoning: CERTIFICATE OF CITY, TOWNSHIP OR COUNTY CLERK
I HEREBY CERTIFY THAT THE PREMISES AT l 301 S ~~
Location Street Address
(Check one box in each section below)
CITY LIMITS: Iii Inside the incorporated city limits D Outside the city limits
'l,oV\U.. C.-~ 't>A
~' J!s (efl'{of IS:
City Zip
County
~ City Clerk D Township Clerk D County Clerk.
DATE >J/z:z/u... PHONE bTts-)~~ 1'
~I understand that I must maintain a copy of the approved diagram on the licensed premise and it must be available for
immediate inspection upon request.
a ies of perjury, I declare the information contained in this document a true, accurate and complete disclosure of information.
0
Date
ABC Office Use Only
D DIAGRAM APPROVED AS SUBMITTED Signature of ABC Official Date
D DIAGRAM DENIED
Reason Denied:
ABC-816 (Rev. 07/19)
Page 3 of 3
. . .
Alcoholic Beverage Control
109 SW 9th Street, 5th Floor
PO Box 3506
Topeka KS 66601-3506
Phone: 785-296-7015
Fax: 785-296-7185
Kdor _ abc.email@ks.gov
www.ksrevenue.gov/abcindex.htrnl
REQUEST FOR TEMPORARY EXTENSION OF PREMISE (ABC-816)
WHICH FORM DO I NEED TO COMPLETE?
Complete and submit this REQUEST FOR TEMPORARY PREMISE APPROVAL (ABC-816) if you :
~ currently possess a liquor license and are applying for a temporary extension of your licensed premise. If you do
not have control of the area you are extending into, you must provide written permission from the owner or
the city/county.
~ If you are extending into public streets, alleys, roads, sidewalks or highways, you must provide a copy of the ordinance or
resolution approval issued by the local governing body.
Complete and submit the REQUEST FOR PERMANENT PREMISE APPROVAL (ABC-806) if you:
~ are applying for a new liquor license.
~ currently possess a liquor license and are applying for a permanent change to your existing licensed premise.
~ currently possess a liquor license and are changing your location. You must also complete and submit the
ABC LIQUOR LICENSE/PERMIT BUSINESS NAME AND/OR ADDRESS CHANGE FORM (ABC-22) along with a
copy of your lease or deed.
All forms may be found on our website at: https://ksrevenue.gov/abcforms.html
INSTRUCTIONS FOR THIS TEMPORARY EXTENSION OF PREMISE REQUEST (ABC-816):
1. LICENSEE INFORMATION. Enter the licensee information requested.
2. TEMPORARY EXTENSION INFORMATION. Check the appropriate box(es).
a. If licensee does not have control of the premises, attach written permission from the property owner or city/county to this
form before submission.
b. If licensee is to extend onto a public street, alley, road, sidewalk or highway, attach the approved ord inance/
resolution to this form before submission.
3. DIAGRAM. Check the appropriate box, then draw a complete diagram of the premises for which you are seeking
license approval or attach your own drawing, provided it is no larger than 8Y:z X 11 , to this form.
a. The diagram must include all entrances, exits and interior doors, walls, coolers, bars, liquor storage space,
kitchen, counters, sales area, office, restrooms, premises boundaries, etc.
b. The diagram must show approximate dimensions of the premise for which you are seeking approval.
c. The diagram must indicate your current premise (if applicable) as well as the temporary extension area.
4. ZONING. Take the form to the city/county clerk to complete the zoning section of the form.
5. Sign and date form.
6. Submit your completed request to the ABC by mail, fax or email to KDOR_ABC.Licensing@ks.gov at least 10
calendar days prior to the temporary extension event date.
CONTACT INFORMATION:
If you have questions or need assistance, please contact us by:
~ Phone: 785-296-7015; or, Email:
~ KDOR_ABC.Email@ks.gov
ABC-816 (Rev. 07/19)
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