Dbpr Form Ab&t 4000a-135-2 - Beer Manufacturer'S Monthly Report
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3DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-135-1
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE FL 32399-1022
BEER MANUFACTURER'S MONTHLY REPORT
BEER MANUFACTURED IN FLORIDA
Prepare in TRIPLICATE. Submit ORIGINAL and FIRST COPY to the AUDITING 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".
(
)
Name
Phone No
License No.
Address
City
FL 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
16 Oz or Less
> 16 Oz to 32 Oz
Bulk Gallons
Taxable Consumption
Gifts to Employees
Shortage on Inbound Transfers
Total
COMPUTATION OF TAX
$
16 Oz or Less
@
$
0.06
each
$
> 16 Oz to 32 Oz
@
$
0.12
each
$
Bulk Gallons
@
$
0.48
each
$
GROSS TAX
$
LESS: DISCOUNT OF 2.5%
$
$
NET AMOUNT EXCISE TAX
003020
DAB&T USE ONLY
REPORT RECEIPT
In'ls
PAYMENT VERIFICATION
In'ls
FIELD REVIEW
In'ls
CENTRAL PROCESSING
In'ls
Postmark Date
Receipt No.
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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