Definitions
ARIZONA FORM
835
Domestic Farm Winery / Domestic Microbrewery / Domestic Cider
Return of Liquor Sold
This return and the tax shown is due not later than the 20
th
day of the 1
st
month following the month for
which this return is made and is delinquent if the tax is not paid within ten (10) days after the due date.
LIQUOR LICENSE NO.
TAXPAYER ID (EIN OR SSN)
FOR THE MONTH OF (enter full month and 4-digit year)
MONTH YYYY
LEGAL BUSINESS NAME
BUSINESS (OR DBA) NAME
MAILING ADDRESS
ADDRESS OF BUSINESS LOCATION
Check if new.
Check if new.
CITY
STATE
ZIP
CITY
STATE
ZIP
NAME OF CONTACT PERSON
TELEPHONE NUMBER (with area code)
Check if new.
Check if new.
E-MAIL ADDRESS
FAX NUMBER (with area code)
Check if new.
Check if new.
File a separate return for each license. Read
instructions
beginning on page 4 prior to completing the return.
(a)
(b)
(c)
VINOUS
MALT
CIDER
No. of Gallons
No. of Gallons
No. of Gallons
1. Gallons sold ......................................................................
2. Deductions – total gallons:
a. Sold to military installations – from Schedule B ...........
b. Exported from Arizona – from Schedule C ...................
c. Sold to Arizona wholesalers – from Schedule D ..........
d. Tax paid – beverage returned.......................................
3. TOTAL DEDUCTIONS (Add lines 2a through 2d) ...............
4. Other Adjustments – gain or loss ........................................
5. Taxable gallons sold to consumers/
Arizona retail stores .........................................................
$
0.84
$
0.16
$
0.16
6. Tax Rates ...........................................................................
$
$
$
7. Tax Due (Multiply line 5 by line 6) .......................................
$
8. TOTAL TAX DUE: (Add line 7, columns a, b, and c) ...................................................................................
Declaration of preparer (other than taxpayer) is based on all
I have read this report and any attachments with it. Under penalties of
information of which preparer has any knowledge.
perjury, I declare that to the best of my knowledge and belief, they are
correct and complete.
PREPARER’S SIGNATURE
TAXPAYER’S OR AUTHORIZED AGENT’S SIGNATURE
PREPARER’S TIN
DATE
TITLE
DATE
Please mail to:
Arizona Department of Revenue, Liquor Tax, 1600 West Monroe, Phoenix, AZ 85007
ADOR 14-2049f (2/07)
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