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Industrial Alcohol Report C-214 - Texas

Industrial Alcohol Report Form. This is a Texas form and can be used in Alcoholic Beverage Commission Statewide .
 Fillable pdf Last Modified 4/12/2011
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FORM C-214 (01/11) INDUSTRIAL ALCOHOL REPORT Monthly Report of Alcohol Produced, Used or Possessed for the Purpose of Use for Industrial, Medicinal, Mechanical or Scientific Purposes During the Month/Year of: TABC USE ONLY ENTRY SUMMARY SCHEDULE A SCHEDULE B TRADE NAME: ADDRESS: CITY: ZIP CODE: PERMIT NUMBER: I/LI PHONE NUMBER: Summary - Do Not Include Denatured Alcohol 1. Inventory, Beginning of Month (Line 5 of Prior Monthly Report) 2. Alcohol Received (Schedule A) 3. Alcohol Produced 4. Total Gallons (Lines 1,2,3) 5. Inventory, End of Month 6. Alcohol Used 7. Alcohol Shipped (Schedule B) 8. Total Gallons (Lines 5,6,7) 9. Alcohol Unaccounted For (Line 4 - 8) - attach explanation Gallons Industrial Alcohol used for the following purposes: AFFIRMATION, Under penalty of perjury, I swear I am an officer or an authorized representative of the above Permittee, and I have examined this report, and confirm it is true, correct, and complete. Signature E-Mail Address Title Date INSTRUCTIONS: This form and any attachments must be filed on or before the 15th day of each month, following each reporting period. Mail to TABC, PO BOX 13127, AUSTIN, TX 78711-3127 or submit electronically to the e-mail address below. Retain one copy for your files for a period of four years. As long as your permit remains active, you must file a report even if no business was conducted. For assistance, please contact the Tax Division at (512) 206-3342 or excise.tax@tabc.state.tx.us. Page 1 American LegalNet, Inc. www.FormsWorkFlow.com FORM C-214 (01/11) ALCOHOL RECEIVED - Schedule A INVOICE DATE INVOICE NUMBER (Retain invoices for audit purposes) CITY STATE GALLONS COMPANY NAME TOTAL GALLONS RECEIVED (To Line 2, Page 1) ALCOHOL SHIPPED - Schedule B INVOICE DATE INVOICE NUMBER (Retain invoices for audit purposes) CITY STATE GALLONS COMPANY NAME TOTAL GALLONS SHIPPED (To Line 7, Page 1) Page 2 American LegalNet, Inc. www.FormsWorkFlow.com
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