Excise Tax Report Form

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E
T
R
F
XCISE
AX
EPORT
ORM
F
OR
M
D
IXED
RINKS ONLY
Month:
__________________
Year: _______________
Name of Business: ___________________________________________________________
Contact Person Name and Phone: ________________________________________________
Monthly excise tax reports and fees are due on the 20
th
of the month by 5:00 PM.
(If received after the 20
th
, a 10% penalty will be added and the vendor’s deduction will not be allowed.)
Excise Tax Reporting:
Line 1: Gross Sales
(sale of distilled spirits by the drink, excluding malt beverages)
$
Line 2: Tax Due
(3% of line 1)
$
Line 3: Vendor’s Deduction
(3% of line 2 *allowed only if payment received by the 20
th
)
$
Total
(subtract line 3 from line 2)
$
Inventory Reporting (Liquor only): list inventory purchases from licensed wholesalers for this period. (you may use a
separate sheet of paper and attach if necessary)
Wholesaler Name
Liters Purchased
Pouring Information (liquor only)
1. Average ounces per drink poured ______oz
2. Average price per drink sold
$________
Total Liters Purchased
I certify the above information is true and correct. This application and any attachments contain no false or fraudulent
information.
_________________________________________________________
________________________
signature and printed name of person preparing report
date
_________________________________________________________
________________________
signature and printed name of licensee
date
Total Amount Due: $________________
(make check payable to City of Suwanee)
Received by:
Date:
This return is subject to audit; please maintain a copy for three (3) years.
City of Suwanee
Finance Department
330 Town Center Avenue
Licensing and Revenue Section/Alcohol Beverage Unit
Suwanee, GA 30024
770-945-8996

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