If the address is incorrect, make any changes necessary. þ en-USForm O-255en-USWholesale Alcoholic Beverages Tax Returnen-US(Rev. 09/18)en-USDepartment of Revenue Servicesen-USPO Box en-US5034en-USHartford CT 06102-5034en-USO255 0918W 01 9999 1. þ en-USAmount of tax: Total Line 17, Columns 1 through 8, on reverse side. þ 1. þ en-US þ en-US.en-US00 2. þ Tax credits: Attach authorized letter. þ 2. þ en-US þ en-US.en-US00 3. þ Adjusted tax: Line 1 minus Line 2. þ 3. þ en-US þ en-US.en-US00 4. þ Penalty þ 4. þ en-US þ en-US.en-US00 5. þ Interest þ 5. þ en-US þ en-US.en-US00 6. þ en-USTotal amount due: Add Lines 3, 4, and 5. þ 6. þ en-US þ en-US.en-US00 7. þ Are any of your inventories or accounts receivable pledged at this time? þ Yes þ No en-USDeclarationen-US: I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and, to the best of en-USen-USen-USinformation of which the preparer has any knowledge.en-USSign Hereen-USKeep aen-US en-UScopy ofen-US en-USthis returnen-USfor youren-USrecords. en-USTaxpayer signature þ Title þ Date en-US(MMDDYYYY) Print taxpayer name þ Telephone number þ Taxpayer SSN Paid preparer signature þ Preparer address þ Preparer222s SSN or PTIN en-USRead the instructions before you complete this return.en-USComplete the return in blue or black ink.en-USTaxpayer222s email address en-USen-USen-USremittance for tax due.en-USDue Date: en-USen-USfollowing the period indicated. en-USReturn for period ended en-USen-USDue on or before en-USM M - D D - Y Y Y Y en-USM M - D D - Y Y Y Y en-USCT Tax en-USRegistration Numberen-USen-USFederal Employer ID Numberen-US Out of business þ Amended return þ en-USNameen-USStreet address City/town þ State þ Zip Code American LegalNet, Inc. www.FormsWorkFlow.com en-USForm O-255en-US en-USPage 2 of 3en-US en-US(Rev. 09/18)en-USO255 0918W 02 9999 en-USContinue to Columns 5, 6, 7, and 8, on Page 3 to complete the Tax Amount calculation.en-USSchedule 1 -en-USAmount of Taxen-USWine Gallonsen-USColumn 2en-USBarrelsen-USColumn 1en-USWine Gallonsen-USColumn 3en-USWine Gallonsen-USColumn 4en-USBeer, Malt Beverages, or Cideren-USStill Wines - Not more than 21% alcoholen-US. en-US(Including cider en-UScontaining more than 7% and not more than 21% alcohol)en-USProduced by en-US en-USwineries which are en-US en-USnot small wineriesen-USProduced by small wineriesen-US en-US(Producing 55,000 wineen-US en-USgallons or less per year)en-USConverten-USdraft sizeen-USto barrels.en-USAll other containers en-US en-US(Including cider containing not en-USmore than 7% alcohol) 1. þ Physical inventory at start en-US of month þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 2. þ Quantity purchased or en-US acquired (Sch. A) þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 3. þ Tax-paid purchases and en-US returns (Sch. B) þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 4. þ Produced by manufacturing en-US process þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 5. þ en-USTotals: Add Lines 1 through 4. þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 6. þ Quantity emptied for en-US Item 4 above þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 7. þ Physical inventory at end en-US of month þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 8. þ Adjustments, gain, or en-US loss: Explain. þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 9. þ en-USTotal deductions:en-US Adden-US Lines 6, 7, and 8. þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 10. þ en-USAccountable Balance:en en-USLine 5 minus 9. 11. þ Tax-paid purchases and en-US returns (Sch. B) þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 12. þ Shipments outside en-US Connecticut (Sch. C) þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 13. þ Shipments within en-US Connecticut (Sch. D) þ en-USen-US þ en-USen-US þ en-USen-US þ en-USen-US13a. On-premises sales ofen-US en-USmalt beverages/beeren-US en-US(en-USForm BT-9 Schedule E ) þ en-US 14. þ en-USTotal non-tax deductions: en-US en-USAdd Lines 11, 12, 13,en-US and 13a þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 15. þ en-USTaxable net quantity:en Line 10 less Line 14. þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 16. þ Tax rate for each of the en-US en-UScolumns en-USTax Amount for Each Alcoholic Beverage 17. þ Multiply Line 15 by Line 16 for en-US each column. þ en-USen-US .00 þ en-USen-US .00 þ en-USen-US .00 þ en-USen-USen-US.00 en-USDEDUCTIONSen-USNON-TAXABLE DEDUCTIONS @ þ $7.20 @ þ $0.24 @ þ $0.72 @ þ $0.18 Connecticut en-US en-USTax Registration en-USNumber American LegalNet, Inc. www.FormsWorkFlow.com en-USForm O-255en-US en-USPage 3 of 3en-US en-US(Rev. 09/18)en-USO255 0918W 03 9999 Connecticut en-US en-USTax Registration en-USNumber en-USProof Gallonsen-USColumn 7en-USWine Gallonsen-USColumn 5en-USWine Gallonsen-USColumn 6en-USWine Gallonsen-USColumn 8en-USDistilled Liquorsen-USen-US(More than 21% Alcohol) and en-USSparkling Winesen-US(Including cider containingen-US en-USmore than 21% alcohol)en-USAlcohol and Componentsen-US en-USfor Manufacturingen-USLiquor Coolers en-US(Not more than 7% alcohol)en-USSchedule 1 -en-USAmount of Tax (con222t) 1. þ Physical inventory at start en-US of month þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 2. þ Quantity purchased or en-US acquired (Sch. A) þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 3. þ Tax-paid purchases and en-US returns (Sch. B) þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 4. þ Produced by manufacturing en-US process þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 5. þ en-USTotals: Add Lines 1 through 4. þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 6. þ Quantity emptied for en-US Item 4 above þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 7. þ Physical inventory at end en-US of month þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 8. þ Adjustments, gain, or en-US loss: Explain. þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 9. þ en-USTotal deductions:en-US Adden-US Lines 6, 7, and 8. þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 10. þ en-USAccountable Balance:en en-USLine 5 minus 9. 11. þ Tax-paid purchases and en-US returns (Sch. B) þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 12. þ Shipments outside en-US Connecticut (Sch. C) þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 13. þ Shipments within en-US Connecticut (Sch. D) þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 14. þ en-USTotal non-tax deductions: en-US Add Lines 11, 12, and 13. þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 15. þ en-USTaxable net quantity:en Line 10 less Line 14. þ en-USen-US þ en-USen-US þ en-USen-US þ en-US 16. þ Tax rate for each of the en-US en-UScolumns en-USTax Amount for Each Alcoholic Beverage 17. þ Multiply Line 15 by Line 16 for en-US each column. þ en-USen-USen-US.00 þ en-USen-US .00 þ en-USen-US .00 þ en-USen-USen-US.00en-USTotal Line 17, Columns 1 through 8 (Pages 2 and 3). Transfer this amount to Line 1 on the front. þ en-USen-US.00en-USDEDUCTIONSen-USNON-TAXABLE DEDUCTIONS @ þ $5.40 @ þ $1.80 @ þ $5.40 @ þ $2.46 American LegalNet, Inc. www.FormsWorkFlow.com en-USForm O-255 (Rev. en-US09/18en-US)en-USen-USBeer, Malt Beverages, and Cider en-US(Columns 1 and 2) include en-USbeer, ale, porter, stout, lager beer, or any other product of en-USfermentation, infusion, or decoction of barley, malt, and hops en-USin drinking water and containing more than 0.5% of absolute en-USalcohol by volume. Alcoholic cider containing not more than en-US7% of absolute alcohol is taxed at the beer rate.en-USStill Wines and Cider Not Taxed at the Beer Rateen-US en-US(Columns 3 and 4) include any wine that contains not more en-USthan 0.392 of a gram of carbon dioxide per 100 milliliters of en-USen-USfermentation of the juice of apples (except cider taxed at en-USen-UScompound sold as still wine containing more than 3.2% of en-USabsolute alcohol by volume. Includes cider containing more en-USthan 7% but not more than 21% of absolute alcohol and en-UScontaining not more than 0.392 of a gram of carbon dioxide en-USper 100 milliliters.en-USSmall Wineriesen-US (Column 4) include persons producing not en-USmore than 55,000 wine gallons of wine in the preceding en-USen-USDistilled Liquors en-US(Column 5) include any beverage that en-UScontains al