Brewer Of Malt Liquor Excise Tax And Premium Report
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Brewer Of Malt Liquor Excise Tax And Premium Report Form. This is a Maine form and can be use 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
WINERY
TABLE WINE
EXCISE TAX & PREMIUM REPORT
___________________________________
_______________________________________
NAME OF LICENSE HOLDER
LICENSE NUMBER
______________________________________
NAME OF WINERY
___________________________________________
CURRENT LICENSE EXPIRES
_____________________________________
STREET ADDRESS
__________________________________________
MONTH OF WITHDRAWL
_____________________________________
TOWN
ZIP
__________________________________________
PHONE #
(1) TOTAL GALLONS OF TABLE WINE WITHDRAWN
FROM BOND THIS LICENSE YEAR TO DATE.
(1)______________________________________
(2) TOTAL GALLONS OF TAX PAID TABLE WINE PREVIOUSLY REPORTED TO
LIQUOR LICENSING AND INSPECTION UNIT THIS YEAR.
(2) _____________________________________
(3) TOTAL GALLONS WITHDRAWN THIS MONTH.
(SUBTRACT LINE 2 FROM LINE 1)
(3) _____________________________________
(4) LESS TOTAL CREDITS CLAIMED.
(ATTACH DOCUMENTARY EVIDENCE TO JUSTIFY CLAIM)
(4) _____________________________________
(5) TOTAL TAXABLE GALLONS THIS MONTH.
(5) _____________________________________
(6) NET EXCISE TAX DUE.
(MULTIPLY LINE 5 X .30)
(6) _____________________________________
(7) NET PREMIUM DUE
(ENTER AMOUNT ON LINE 6)
(7) _____________________________________
(8) TOTAL NET TAX DUE.
(ADD LINES 6 & 7)
(8) _____________________________________
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
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