Craft Distilleries - Farm Winery - Microbrewery - Cider And Or Direct Shipment Licensee {835}

Arizona Form 835 Craft Distilleries/Farm Winery/Microbrewery/Cider/Direct Shipment Licensee Return of Liquor Sold This return and the tax shown is due not later than the 20th day of the 1st month following the month for which this return is made and is delinquent if the tax is not paid within ten (10) days after the due date. Amended Return Legal Business Name Business (or dba) Name Mailing Address City Business Location Address City Name of Contact Person E-mail Address State ZIP Code NEW NEW Final Return (LICENSE CANCELED) New License Number Liquor License Number: Taxpayer I.D. Number: Period Beginning: Period Ending: MMD D Y Y Y Y MMD D Y Y Y Y REVENUE USE ONLY. DO NOT MARK IN THIS AREA. 88 State ZIP Code NEW Telephone No. Fax No. NEW 81 PM 80 RCVD NEW NEW File a separate return for each license. Read instructions beginning on page 4 prior to completing the return. (a) SPIRITS (b) VINOUS No. of Gallons (c) MALT / CIDER 1. Gallons sold ...................................................................... 2. Deductions ­ total gallons: a. Sold to military installations ­ from Schedule B ............ b. Exported from Arizona ­ from Schedule C .................... c. Sold to Arizona wholesalers ­ from Schedule D ........... d. Tax paid ­ beverage returned........................................ 3. TOTAL DEDUCTIONS (Add lines 2a through 2d)............... 4. Other Adjustments ­ gain or loss ........................................ 5. Taxable gallons sold to consumers/ Arizona retail stores ......................................................... 6. Tax Rates ........................................................................... 7. Tax Due (Multiply line 5 by line 6)....................................... 0.0000 0.0000 0.0000 0.0000 $ $ 3.00 0.00 $ $ 0.0000 0.84 0.00 $ $ $ 0.0000 0.16 0.00 0.00 8. TOTAL TAX DUE: (Add line 7, columns a, b, and c) .................................................................................... Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Under penalties of perjury, I declare that to the best of my knowledge and belief, they are correct and complete. PREPARER'S SIGNATURE TAXPAYER'S OR AUTHORIZED AGENT'S SIGNATURE PREPARER'S TIN DATE TITLE DATE Please mail to: Arizona Department of Revenue, Liquor Tax, PO Box 29019, Phoenix, AZ 85038-9019 ADOR 11081 (2/17) American LegalNet, Inc. www.FormsWorkFlow.com Arizona Form 835 Name (as shown on page 1) Liquor License Number Taxpayer I.D. Number For the Period of: to SCHEDULE B TAX FREE SALES of Spirits, Vinous and Malt/Cider Liquors During the Month INVOICE CITY STATE DATE NUMBER SPIRITS NO. OF GALLONS VINOUS MALT CIDER NAME OF PURCHASER . . . . B1 Total this sheet ........................................................................................................................................ B1 B2 Total all continuation sheets .................................................................................................................... B2 B3 TOTAL GALLONS THIS MONTH: Enter here and on page 1, line 2a ................................................... B3 . . . . . . . . . . . . . . . . . . . . SCHEDULE C OUT-OF-STATE SALES of Spirits, Vinous and Malt/Cider Liquors During the Month INVOICE CITY STATE DATE NUMBER SPIRITS NO. OF GALLONS VINOUS MALT CIDER NAME OF PURCHASER . . . . C1 Total this sheet ........................................................................................................................................ C1 C2 Total all continuation sheets .................................................................................................................... C2 C3 TOTAL GALLONS THIS MONTH: Enter here and on page 1, line 2b ................................................... C3 . . . . . . . . . . . . . . . . . . . . SCHEDULE D SALES TO LICENSED ARIZONA WHOLESALERS of Spirits, Vinous and Malt/Cider Liquors During the Month INVOICE CITY STATE DATE NUMBER SPIRITS NO. OF GALLONS VINOUS MALT CIDER NAME OF PURCHASER/SUPPLIER . . . . D1 Total this sheet ........................................................................................................................................ D1 D2 Total all continuation sheets .................................................................................................................... D2 D3 TOTAL GALLONS THIS MONTH: Enter here and on page 1, line 2b ................................................... D3 ADOR 11081 (2/17) . . . . . . . . . . . . . . . . Arizona Form 835 . . . . American LegalNet, Inc. www.FormsWorkFlow.com Page 2 Arizona Form 835 Name (as shown on page 1) Liquor License Number Taxpayer I.D. Number For the Period of: to Continuation Page INVOICE NAME OF PURCHASER/SUPPLIER CITY STATE DATE NUMBER SPIRITS Schedule ­ Sheet of NO. OF GALLONS VINOUS MALT CIDER . . . . . . . . . . . . . . . . . . . . . . . . TOTAL THIS SHEET: Enter amount on Schedule B, C, or D ....................................................................... ADOR 11081 (2/17) American LegalNet, Inc. www.FormsWorkFlow.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Arizona Form 835 Arizona Form 835 Craft Distilleries/Farm Winery/Microbrewery/Cider/Direct Shipment Licensee Return of Liquor Sold "Spirituous Liquor" means any liquid containing more than one-half of 1% alcohol by volume that is produced by distillation of any fermented substance and is used or prepared for use as a beverage. "Malt Liquor" means any liquid containing more than onehalf of 1% alcohol by volume and is made by the process of fermentation and not distillation of hops or grains but not including liquids made by the process of distillation of such substances. GENERAL INSTRUCTIONS are a domestic craft distillery, a domestic farm winery, a domestic microbrewery, or a domestic cider producer who manufactures or produces on the premises and sells at retail or to retail licensees within the State of Arizona, or a direct shipment licensee that sells at retail or to retail licensees within the State of Arizona. before the 20th day after the month the tax accrues. Prepare this return for each month regardless of whether or not any tax is due. File the original with the Arizona Department of Revenue. Retain a copy of the form with all substantiating documentation for at least four years, subject to inspection by the Department. SPECIFIC INSTRU