Departmental Use Only MONTHLY REPORT OF EXCISE TAX FOR ALCOHOL BEVERAGES DR 0442 (12/29/09) COLORADO DEPT OF REVENUE DENVER CO 80261 (303) 205-8211 EXT. 6848 Are you paying your taxes by EFT? Yes No RETURN THIS COPY Show change of ownership, name and/or address here. PHOTOCOPY AND KEEP COPY FOR YOUR RECORDS USE ACCOUNT NUMBER for all reference LIABILITY INFORMATION Cnty City LT Type Liability Date PERIOD COVERED DUE DATE MAKE REMITTANCE PAYABLE TO: COLORADO DEPARTMENT OF REVENUE (1800-100) (1820-100) (1810-100) (1860-100) (1840-100) VINOUS LIQUOR (LITERS) SPIRITUOUS LIQUOR (LITERS) HARD CIDER (GALLONS) MALT LIQUOR (GALLONS) 3.2% BEER (GALLONS) 1. Beginning inventory..................................................... 2. Manufactured in Colorado (Manufacturers only) alternating proprietors attach form DR 0447. ................ 3. Purchased tax not included, attach form DR 0445......... 4. Purchased tax included, attach form DR 0445............... 5. Total Lines 1,2,3, and 4................................................ 6. Ending inventory.......................................................... 7. Line 5 minus Line 6. .................................................... 8. Tax exempt dispositions: (a) Export sales, attach form DR 0443.......................... (b) Sales exempt by federal law...................................... (c) Destruction (d) Total tax exempt. Add lines 8(a), 8(b) and 8(c) 9. Taxable liters/gallons, Line 7 minus Line 8(d). ................ . 10. Sales included in Line 9 previously taxed...................... 11. Tax due liters/gallon sold, Line 9 minus Line 10............ 12. Tax rate..................................................................... $ 13. Tax: (a) Line 11 multiplied by Line 12.......................... (100) $ .0733 $ .6026 $ $ .08 $ $ .08 $ $ .08 $ (b) Wine development fee 1¢/liter....... 1865-100 (100) $ (c) CO winery surcharge (send form DR 0450) .......................................................................... 1866-100 (100) $ (d) CO grape/produce $10.00/ton....... 1867-100 (100) $ $ $ $ $ $ $ 15. Interest @ 1% per month.......................................(300) 16. Total due, Add Lines 15, 16, and 17.............................. $ . $ $ $ $ (e) Total tax, add Lines 13(a) through 13(d). ................ 14. Penalty @ 10%......................................................(200) The State may convert your check to a one time electronic banking transaction. Your bank account may be debited as early as the same day received by the State. If converted, your check will not be returned. If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically. 17. TOTAL REMITTANCE, ALL COLUMNS................................................................................ (355) $ PLEASE INCLUDE THE ACCOUNT NUMBER ON YOUR CHECK TO ENSURE PROPER CREDIT I hereby certify under penalty of perjury that the statements made herein, and on supporting documents, are true and correct to the best of my knowledge. Signature of Agent or Officer Date Title Telephone Number American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR FORM DR 0442 Who Must File. Colorado licensed 3.2 beer or liquor manufacturer, wholesaler or Winery Direct Shippers Permit holder. Out-of-State Winery Direct Shippers & Personal Inventory returns – START HERE. Enter the total number of liters sold in or shipped to Colorado on line 11. Tax Imposed. When first sold, transferred, or otherwise disposed of in Colorado by: • Licensed Wholesaler • Licensed Manufacturer/Alternating Proprietor. Line 11. Colorado manufacturers or wholesalers subtract line 10 from line 9 for the total taxable liters and/or gallons sold. Line 1. Ending inventory listed in liters or gallons from prior month’s line 6. Line 13(a). Multiply line 11, taxable liters/gallons, times line 12. Line 2. Colorado Manufacturers only report all product manufactured in Colorado, bottled and ready for sale. Alternating Proprietors attach Schedule DR 0447. Line 3. All product purchased during the month, which the Colorado excise tax has not been paid. Attach supporting schedules(s) DR 0445. Line 12. Preprinted applicable tax rates. Line 13(b). Wine development fee. Multiply 1 cent times the number of liters on line 11. Line 13(c). Winery manufacturers surcharge on wine produced in Colorado and included in tax due sales on line 11. (See worksheet DR 0450 provided by the Department and available on our website) Line 4. All product purchased during the month, which the Colorado excise tax has already been paid. Attach supporting schedule(s) DR 0445. Line 13(d). Colorado Winery grape tax for produce used in the Colorado production of wine by a licensed Colorado winery. The rate is $10.00 per ton and is included in the month the product was used, purchased or imported into Colorado, whichever is later. Line 5. Total lines 1, 2, 3 and 4. All product in inventory and available for sale in Colorado. Line 13(e). Net tax due. Total tax due by category. Enter total of lines 13(a) through 13(d). Line 6. All product left in inventory at end of the month. Line 14. If the return is filed after the due date, enter the late filing penalty of 10% times the net tax due on line 13(e). Line 7. Subtract line 6 from line 5. All product removed from inventory during the month. Line 8(a). All product sold outside of Colorado. Attach supporting schedule(s) DR 0443. Line 15. If the return is filed after the due date, enter the interest charge of 1% per month or fraction thereof times the total of lines 13(e) and line 14. Line 16. Enter the total of lines 13(e), 14 and 15. Line 8(b). All wine, distilled liquor and hard cider sold and delivered to ceded federal property (e.g., military). Line 8(c). All product unsaleable due to destruction or damage. (Credit is not allowed for spoilage). An affidavit of destruction or damage must be submitted. Line 8(d). Total of lines 8a, 8b, and 8c. Total amount exempt from Colorado excise tax for the month. Line 9. Subtract line 8d from line 7. Line 10. Amount of product included on line 9 that already has Colorado excise tax paid. For more information, visit our website www.TaxColorado.com American LegalNet, Inc. www.FormsWorkFlow.com