Dbpr Form Ab&t 4000a-105-3 - Liquor Manufactirer'S Monthly Report
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3DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-105-1
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE, FL 32399-1022
LIQUOR MANUFACTIRER'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. Make remittances payable to the
"Division of Alcoholic Beverages and Tobacco".
Licensee Name
Phone No.
(
)
License No.
Address
City
FL
Zip
Month Reported
20
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
Report Receipt
In'ls
Field Review
In'ls
Central Processing
In'ls
Postmark Date
Initial Review Date
Initial Receipt Date
Delivery Date
Amended Date
Completed Date
Delinquency Action
Amended Amount
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