Page 1 ATT-29 (Rev. 5/14) Georgia Department of Revenue Alcohol and Tobacco Division 1800 Century Center Suite 4235 Atlanta, GA 30345 Telephone: (404) 417-4900 E-mail: ATDIV@dor.ga.gov Due by the 15th of each month following month in which shipments were made MONTHLY REPORT OF MALT BEVERAGE SHIPMENTS INTO THE STATE OF GEORGIA Submit online at https://gtc.dor.ga.gov Report for _______________________ REPORT BY LICENSE NO. STREET ADDRESS CITY STATE ZIP CODE IMPORTANT Give below a grand total, in number of cases or kegs according to packing and size container of all malt beverage shipments to distributions located in the State of Georgia as reflected on Schedules of Shipments. NUMBER OF CASES OR KEGS (A) ______________ (B) ______________ (C) ______________ (D) ______________ (E) ______________ (F) ______________ (G) ______________ 48/7 36/8 24/12 24/14 24/16 12/32 24/7 SIZE OF CASES OR KEGS oz. Cases oz. Cases oz. Cases oz. Cases oz. Cases oz. Cases oz. Cases NUMBER OF CASES OR KEGS (H) ______________ (I) ______________ (J) ______________ (K) ______________ (L) ______________ Misc. oz Total BBL Total 24/8 12/12 1/6 1/2 ____ ____ ____ ____ SIZE OF CASES OR KEGS oz. Cases oz. Cases bbl. kegs bbl. kegs Cases ________ ________ ________ ______________ ______________ _____________ Grand Total Gallons AFFIDAVIT I certify, under the penalties for filing false returns, that I have personal knowledge and understanding of statements made in this return and that the figures presented herein, including accompanying materials are true, correct and complete to the best of my knowledge and belief, and are filed in accordance with the law. __________________________________________ SIGNATURE OF OWNER, PARTNER OR OFFICER ______________________ TITLE ____________ DATE American LegalNet, Inc. www.FormsWorkFlow.com Page 2 ATT-29 (Rev. 5/14) Georgia Department of Revenue Alcohol and Tobacco Division 1800 Century Center Suite 4235 Atlanta, GA 30345 Telephone: (404) 417-4900 E-mail: ATDIV@dor.ga.gov BREWERS SCHEDULE OF MALT BEVERAGE SHIPMENTS TO EACH DISTRIBUTOR LOCATED IN THE STATE OF GEORGIA FOR ____________________ SHIPPED TO (NAME OF DISTRIBUTOR) SHIPPED TO (CITY OF DISTRIBUTOR) SHIPPED TO (NAME OF BREWERY) SHIPPED BY (CITY OF BREWERY) INSTRUCTIONS: (1) Complete a separate page for each Distributor in the State of Georgia to whom Malt shipped during the calendar month covered by this report. (2) List each invoice of shipment separately. (3) Copies of all Credit Memorandums issued to Georgia Distributors must be attached to Individual Distributor's Schedule of Shipments. Each Credit Memorandum must have written thereon the reason for its issuance. INVOICE DATE MM/DD/YYYY INVOICE NUMBER (A) (CASES) 48/7 (B) (CASES) 36/8 (C) (CASES) 24/12 (D) (CASES) 24/14 (E) (CASES) 24/16 (F) (CASES) 12/32 American LegalNet, Inc. www.FormsWorkFlow.com Page 3 ATT-29 (Rev. 5/14) Georgia Department of Revenue Alcohol and Tobacco Division 1800 Century Center Suite 4235 Atlanta, GA 30345 Telephone: (404) 417-4900 E-mail: ATDIV@dor.ga.gov BREWERS SCHEDULE OF MALT BEVERAGE SHIPMENTS TO EACH DISTRIBUTOR SHIPPED TO (NAME OF DISTRIBUTOR) SHIPPED TO (CITY OF DISTRIBUTOR) SHIPPED TO (NAME OF BREWERY) SHIPPED BY (CITY OF BREWERY) INVOICE DATE MM/DD/YYYY INVOICE NUMBER (G) (CASES) 24/7 (H) (CASES) 24/8 (I) (CASES) 12/12 (J) (CASES) 1/6 bbl. (K) (CASES) � bbl. (L) (CASES) American LegalNet, Inc. www.FormsWorkFlow.com