Account Information
Account/Control Number
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Location Address
*
Business Name
*
New mailing address - if applicable
Sales for consumption off-premises
For the month ending
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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
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Title
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Phone #
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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.
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