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Distributors Monthly Report Malt Beverage Purchased Sold And Withdrawn Inventories REV-1014 - Pennsylvania
| Distributors Monthly Report Malt Beverage Purchased Sold And Withdrawn Inventories Form. This is a Pennsylvania form and can be used in Department Of Revenue Statewide . |
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REV-1014 AS+ (04-12) BUREAU OF BUSINESS TRUST FUND TAXES MISCELLANEOUS TAX DIVISION PO BOX 280909 HARRISBURG PA 17128-0909 Print or Type BUSINESS NAME ADDRESS STREET REPORTING MONTH/YEAR DISTRIBUTOR'S MONTHLY REPORT MALT BEVERAGE PURCHASED, SOLD AND WITHDRAWN INVENTORIES CITY EIN LICENSE NUMBER STATE LID NUMBER ZIP INSTRUCTIONS: 1. This report and its schedules are due on or before the 15th day after the end of the month for which it is prepared. 2. Type or print figures legibly. Only use black ink when completing reports. Do not use colored ink or pencil. 3. Mail report and schedules to PA DEPARTMENT OF REVENUE, PO BOX 280909, HARRISBURG PA 17128-0909, send electronically to ra-btftmaltbev@pa.gov or fax to 717-705-8413. UNITS DESCRIPTION OTHER BARRELS OTHER INDICATE SIZE GALLON INDICATE SIZE 1 QT. 1/2 PT. 1 PT. 112.1 OZ. CAN & BOTTLE CAN & BOTTLE CAN & BOTTLE TO 7 OZ. TO 8 OZ. 8.1 OZ. TO 16 OZ. 16.1 OZ. TO 32 OZ. 128 OZ. 1/8 1/6 1/4 1/2 1. Reporting Month, Beginning Inventory Purchased from Pennsylvania Manufacturers (Schedule A) Purchased from Importing Distributors (Schedule B) Purchased from Out-of-State Manufacturers (Schedule C, REV-1055) 2. 3. 4. 5. Total (Add Lines 1, 2, 3 & 4) 6. Reporting Month, Ending Inventory Balance to Account For (Line 5 minus Line 6) 7. 8. Sales of Malt Beverage 9. Other Removals. Attach Explanation Total Accounted For (Add Lines 8 & 9) 10. This Total must equal Line 7. I hereby affirm under penalties prescribed by law that this report, including accompanying schedules, has been examined by me and to the best of my knowledge and belief is a true, correct and complete report. NAME OF OWNER OR OFFICER TITLE SIGNATURE NAME OF CORPORATION OR REGISTERED TRADE NAME WITH LIQUOR CONTROL BOARD American LegalNet, Inc. www.FormsWorkFlow.com REV-1014 AS+ (04-12) BUREAU OF BUSINESS TRUST FUND TAXES MISCELLANEOUS TAX DIVISION PO BOX 280909 HARRISBURG PA 17128-0909 Print or Type BUSINESS NAME REPORTING MONTH/YEAR EIN SCHEDULE A MALT BEVERAGE PURCHASED FROM PENNSYLVANIA MANUFACTURES LICENSE NUMBER LID NUMBER UNITS NAME AND ADDRESS OF MANUFACTURES OTHER BARRELS OTHER INDICATE SIZE GALLON INDICATE SIZE 1 QT. 1/2 PT. 1 PT. 112.1 OZ. CAN & BOTTLE CAN & BOTTLE CAN & BOTTLE TO 7 OZ. TO 8 OZ. 8.1 OZ. TO 16 OZ. 16.1 OZ. TO 32 OZ. 128 OZ. 1/8 1/6 1/4 1/2 NAME STREE NAME STREET NAME STREET NAME STREET NAME STREET CITY STATE ZIP CODE CITY STATE ZIP CODE CITY STATE ZIP CODE CITY STATE ZIP CODE CITY STATE ZIP CODE TOTALS NAME AND ADDRESS OF IMPORTING DISTRIBUTORS NAME STREET NAME STREET NAME STREET NAME STREET NAME STREET NAME STREET CITY STATE ZIP CODE CITY STATE ZIP CODE CITY STATE ZIP CODE CITY STATE ZIP CODE CITY STATE ZIP CODE CITY STATE ZIP CODE SCHEDULE B MALT BEVERAGE PURCHASED FROM IMPORTING DISTRIBUTORS TOTALS If additional space is needed, attach facsimiles of these schedules or additional 8 1/2" x 11" sheets. American LegalNet, Inc. www.FormsWorkFlow.com
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