Form 04-501 - Alcoholic Beverage Excise Tax Supporting Schedule Of Gallons Sold Or Consigned

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Alcoholic Beverage Excise Tax
Supporting Schedule of Gallons Sold or Consigned
Business Name
EIN
Month
Year
Page
of
This is a supporting schedule for Alcoholic Beverage Excise Tax Return form 04-500. Use a separate schedule for each of the
categories that applies to your business for the month for which you are making the return. Use additional pages as necessary.
Check one category:
x
A. Gallons sold or consigned into Alaska except gallons removed from a Bonded Warehouse
B. Gallons sold or consigned from a Bonded Warehouse
C. Gallons sold to military establishments
D. Adjustments for allowable credits
Number of Gallons
Name of Consignee
Alaska
Date of
Bill of
or Buyer
Location
Shipment
Lading or
Liquor
Wine
Beer
Invoice Number
TOTALS CARRIED FORWARD
TOTALS
0
0
0
Form 04-501 (Rev. 6/92)

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