Form Com/att-027 - Alcoholic Beverages Public Storage Report
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1
2Comptroller of Maryland
MATT Regulatory Division
Alcohol and Tobacco Tax
P.O. Box 2999
Annapolis, MD 21404-2999
Telephone: 410-260-6381/888-784-0145
Fax # 410-974-3201
Alcoholic Beverages Public Storage Report
Report of
Month of
(Storage Permit Holder Name)
Address
Date
Permit Number
Pursuant to the provisions of Article 2B of the Annotated Code of Maryland, as amended, this report is a complete and
accurate record of all alcoholic beverages received and delivered for the entire month covered and is supported by the
necessary schedules. (See reverse side for instructions)
Beer
Wine
Spirits
A.
Total number of packages on hand first of month .........................
B.
Total number of packages received during month .........................
C.
Combined total ...............................................................................
D.
Total number of packages delivered or shipped during month ......
E.
Total number of packages on hand end of month ..........................
Statement
I certify that this report, together with attached schedules, has been examined by me and is, to the best of my knowledge
and belief, a true and complete report for the month stated, in accordance with the provisions of Article 2B of the
Annotated Code of Maryland, as amended, title “Alcoholic Beverages,” and the regulations issued under authority thereof.
(Name of Public Company)
(Signature)
(Print Name)
(Title: Owner, Partner, Officer or Agent)
COM/ATT-027
REV. 7/07
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