Form Ab&t 4000a-105-1 - Liquor Manufacturer'S Monthly Report
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4DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION
DBPR Form AB&T
4000A-105-1
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Revised 1/99
1940 NORTH MONROE STREET, TALLAHASSEE, FL 32399-1022
LIQUOR MANUFACTURER'S MONTHLY REPORT
BULK SPIRITS MANUFACTURED IN FLORIDA
Prepare in TRIPLICATE. Submit ORIGINAL and FIRST COPY to the AUDITING DISTRICT OFFICE of the DIVISION OF ALCOHOLIC BEVERAGES AND
TOBACCO. SECOND COPY is to be retained by the licensee. This report and payment must be filed in accordance with the provisions of Chapter
561, Florida Statutes, on or before the tenth day of the month following the month being reported.
License Name
Phone #
License #
Address
City
, Florida, Zip
Month Reported
, Yr.
Reporting Period
/
/
through
/
/
.
This report is true and correct to the best of my knowledge and belief and is submitted under penalty of perjury.
Typed Or Printed Name
Authorized Signature
SUMMARY OF TRANSACTIONS
PROOF GALLONS
1.
BEGINNING BALANCE
2.
PRODUCED
3.
RETURNED TO STOCK
4.
RECEIVED FOR BONDED STORAGE
5.
GAIN
6.
7.
TOTAL TO ACCOUNT FOR
8.
SOLD IN STATE
9.
SOLD OUT OF STATE
10.
TRANSFER TO BOTTLING PREMISES
11.
DEDUCTIONS
12.
13.
TOTAL ACCOUNTED FOR
14.
ENDING BALANCE
15.
INVENTORY (ACTUAL)
DAB&T USE ONLY
CENTRAL PROCESSING
REPORT RECEIPT
In'ls
FIELD REVIEW
In'ls
In'ls
Postmark Date
Initial Review Date
Initial Receipt Date
Delivery Date
Amended Date
Completed Date
Delinquency Action
Amended Amount
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