Out Of State Supplier Report Of Alcoholic Beverages Shipped To Delaware Importers
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Out Of State Supplier Report Of Alcoholic Beverages Shipped To Delaware Importers Form. This is a Delaware form and can be use in Statewide.
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OUT OF STATE SUPPLIER REPORT OF ALCOHOLIC BEVERAGES SHIPPED
TO DELAWARE IMPORTERS
TO: DELAWARE DIVISION OF REVENUE
BUSINESS AUDIT BUREAU
ATTN: William J. Kirby
820 N. FRENCH STREET
WILMINGTON, DE 19801
WILLIAM.KIRBY@STATE.DE.US
W =
HS =
LS =
C =
B =
Shipments of alcoholic beverages to Delaware Importers
for the month of:
TYPE
WINES
HIGH SPIRITS
LOW SPIRITS
CIDER
BEER
License No.
Check here if you had no shipments to report during this month.
DATE
INVOICE
NUMBER
P.O.
NUMBER
NAME OF DELAWARE
IMPORTER
TYPE
W,HS.LS
C,B
TOTAL
TOTAL
TOTAL
GALLONS BARRELS
CASES (W,HS,LS,C) (BEER)
The information submitted in the foregoing report is certified to be a full, true and correct statement of the out of state supplier named
below to the knowledge and belief of the undersigned. Copies of invoices are not required. Report is due by the 15th of the month.
NAME OF SUPPLIER
NAME OF OFFICER
DATE
SIGNATURE
TELEPHONE NUMBER
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