Account Information

Account Number *

Location Address *

Business Name *

New mailing address - if applicable

Sales for consumption off-premises

SELECT MONTH ENDING *

Full Barrel (quantities sold)

½ Barrel (quantities sold)

¼ Barrel (quantities sold)

⅙ Barrel (quantities sold)

Case of beer quantities sold (twenty-four 12-oz cans)

64 oz containers (quantities sold)

24 oz containers (quantities sold)

16 oz containers (quantities sold)

12 oz containers ($0.05)

Other Size (1)

Tax Rate ($)

Quantities Sold

Other Size (2)

Tax Rate ($)

Quantities Sold

Other Size (3)

Tax Rate ($)

Qantities Sold

Your Contact Information

Name *

Title *

Phone # *

Email Address *

I certify that this return, including the accompanying schedules or statements, has been examined by me and is, to the best of my knowledge and belief, a true and complete return made in good faith for the period stated.

Upload Supporting Documents

REQUIRED: Monthly liquor sales report OR copy of register tape. Documents are required in PDF and image (JPG,PNG) format. Maximum of three files

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