Form Ab&t 4000a-135-1 - Beer Manufacturer'S Monthly Report
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1
2
3DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION
DBPR Form AB&T
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
4000A-135-1
1940 NORTH MONROE STREET, TALLAHASSEE, FL 32399-1022
Revised 11/98
BEER MANUFACTURER'S MONTHLY REPORT
BEER 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. Make remittances payable to the "Division of
Alcoholic Beverages and Tobacco."
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
TAXABLE SALES
Pints or Less
Quarts
Bulk Gallons
Taxable Consumption
Gifts to Employees
Shortage on Inbound Transfers
Total
COMPUTATION OF TAX
Pints or Less
@
$ 0.06 each
$
Quarts
@
$ 0.12 each
$
Bulk Gallons
@
$ 0.48 each
$
GROSS TAX
$
LESS: DISCOUNT OF 2.5%
$
$
NET AMOUNT EXCISE TAX
$
40031
DAB&T USE ONLY
REPORT RECEIPT
In'ls
PAYMENT VERIFICATION
In'ls
FIELD REVIEW
In'ls
CENTRAL PROCESSING
In'ls
Postmark Date
Receipt Number
Initial Review Date
Initial Receipt Date
Delivery Date
Payment Date
Amended Date
Completed Date
Delinquency Action
Excise Tax Paid
Amended Amount
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