Maine > Statewide > Liquor Licensing And Inspection Division
Brewer Of Malt Liquor Excise Tax And Premium Report - Maine
| Brewer Of Malt Liquor Excise Tax And Premium Report Form. This is a Maine form and can be used in Liquor Licensing And Inspection Division Statewide . |
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DEPARTMENT OF PUBLIC SAFETY LIQUOR LICENSING & INSPECTION UNIT 164 STATE HOUSE STATION AUGUSTA, ME 04333 BREWER OF MALT LIQUOR EXCISE TAX & PREMIUM REPORT ___________________________________ NAME OF LICENSE HOLDER ______________________________________ NAME OF BREWERY _____________________________________ STREET ADDRESS _____________________________________ TOWN ZIP _______________________________________ LICENSE NUMBER ___________________________________________ CURRENT LICENSE EXPIRES __________________________________________ MONTH OF WITHDRAWL __________________________________________ PHONE # (1) TOTAL GALLONS OF MALT LIQUOR WITHDRAWN FROM BOND THIS LICENSE YEAR TO DATE. (2) TOTAL GALLONS OF TAX PAID MALT PREVIOUSLY REPORTED TO LIQUOR LICENSING AND INSPECTION UNIT THIS YEAR. (3) TOTAL GALLONS WITHDRAWN THIS MONTH. (SUBTRACT LINE 2 FROM LINE 1) (4) PLUS TRANSFERS IN FROM OTHER BREWERIES. (ATTACH INVOICES) (5) LESS TOTAL CREDITS CLAIMED. (ATTACH DOCUMENTARY EVIDENCE TO JUSTIFY CLAIM) (6) LESS TRANSFERS OUT TO OTHER BREWERIES. (ATTACH INVOICES) (7) TOTAL TAXABLE GALLONS THIS MONTH. (8) NET EXCISE TAX DUE. (MULTIPLY LINE 7 X .25) (9) NET PREMIUM DUE (MULTIPLY LINE 7 X .10) (10) TOTAL NET TAX DUE. (ADD LINES 8 & 9) (1)______________________________________ (2) _____________________________________ (3) _____________________________________ (4) _____________________________________ (5) _____________________________________ (6) _____________________________________ (7) _____________________________________ (8) _____________________________________ (9) _____________________________________ (10) _____________________________________ PAID BY CHECK #________________________ DATED: ________________________________ SIGNED BY: _____________________________________________ DATED: __________________________________ THIS REPORT MUST BE FILED BY THE 10TH OF THE MONTH IMMEDIATELY FOLLOWING WITHDRAWAL FROM THE BONDED AREA. REVISED 11/2005 American LegalNet, Inc. www.FormsWorkFlow.com DEPARTMENT OF PUBLIC SAFETY American LegalNet, Inc. www.FormsWorkFlow.com
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