FORM M-18 (Rev. 2015) STATE OF HAWAII -- DEPARTMENT OF TAXATION COMBINED MONTHLY RETURN OF LIQUOR TAX AND REPORT OF WINE GALLONS AND DOLLAR VOLUME OF TAXABLE SALES OR USES Month Ending THIS SPACE FOR DATE RECEIVED STAMP LBF151 Name Amended Return Change in Name or Address (For Office Use Only) · PRINT OR TYPE · __ __ / __ __ (MM/YY) Permit No. Hawaii Tax I.D. No. DBA or C/O Address (Number and Street) City or town, State, and Postal/ZIP Code DOLLAR VOLUME (b) WINE GALLONS W ___ ___ ___ ___ ___ ___ ___ ___ - ___ ___ Federal Employer I.D. No./Social Security No. (c) TAX RATE (d) TAX (c x d) CATEGORIES OF LIQUORS AND SALES (a) 1. Distilled Spirits: Military ............................................................ All Others......................................................... Less: Nontaxable and Exempt Sales* ...... Net Taxable Sales ..................................... 2. Sparkling Wine: Military ............................................................. All Others......................................................... Less: Nontaxable and Exempt Sales* ...... Net Taxable Sales ..................................... 3. Still Wine: Military ............................................................. All Others......................................................... Less: Nontaxable and Exempt Sales* ...... Net Taxable Sales ..................................... 4. Cooler Beverages: Military ............................................................. All Others......................................................... Less: Nontaxable and Exempt Sales* ...... Net Taxable Sales ..................................... 5. Beer (Other Than Draft): Military ............................................................. All Others......................................................... Less: Nontaxable and Exempt Sales* ...... Net Taxable Sales ..................................... 6. Beer (Draft): Military ............................................................. All Others......................................................... Less: Nontaxable and Exempt Sales* ...... Net Taxable Sales ..................................... $5.98 per wine gallon 1 $2.12 per wine gallon 2 $1.38 per wine gallon 3 $0.85 per wine gallon 4 $0.93 per wine gallon 5 $0.54 per wine gallon 6 8 9 10 7. Total Tax Due ...................................................................................................................... (Add lines 1 through 6) 7 8. Penalty........................................................................................................................................................................... 9. Interest .......................................................................................................................................................................... 10. Subtotal .............................................................................................................................. (Add lines 7 through 9) 11. Other Adjustments (Attach Schedule) ........................................................................................................................... 11 12. Total Amount Due .............................................................................................................. (Line 10 minus line 11) 12 13. Amount of Payment .................................................................................................................................................... 14. AMENDED RETURNS ONLY - Amount paid (if overpayment enter in parentheses) on original return ....................... 15. AMENDED RETURNS ONLY - Balance due (if refund enter in parentheses) with amended return ............................ *Attach Schedule Liquor Tax Law. Signature ___________________________________________________________ Title _____________________________ Date _______________________ 13 14 15 Mailing address: Hawaii Department of Taxation, P.O. Box 259, Honolulu, HI 96809-0259 DECLARATION: I declare, under the penalties set forth in section 231-36, HRS, that this is a true and correct return, prepared in accordance with the provisions of the FORM M-18 American LegalNet, Inc. www.FormsWorkFlow.com FORM M-18 (REV. 2015) SPECIFIC INSTRUCTIONS: PAGE 2 INSTRUCTIONS · · · · · · · · In computing dollar volume, exclude federal and state excise taxes. Carry wine gallonages to two decimal places. Round up decimals of .005 or larger. Round down decimals of .004 or less. Submit separate schedules for nontaxable sales, exempt sales, and other adjustments. Each nontaxable sale should be separately shown by designating name of purchaser and applicable item number of nontaxable sales indicated below in parentheses before the names of the purchasers: (1) Liquor sold by one permittee to another permittee; (2) Liquor which under the Constitution and laws of the United States cannot be legally subjected to the tax imposed by this chapter so long as and to the extent to which the State is without power to impose the tax; (3) Liquor sold for sacramental purposes or the use of liquor for sacramental purposes, or any liquor imported pursuant to section 281-33, HRS; (4) Alcohol sold pursuant to section 281-37, HRS, to a person holding a purchase permit or prescription therefor, or any sale or use of alcohol, so purchased, for other than beverage purposes. (5) Liquor sold and shipped to a point outside the State for use or resale outside the State pursuant to section 244D-4.3, HRS. Prepare this return for each month and file the original with the Department of Taxation whether or not any tax is due by the twentieth day of the month following the taxable period. Attach check or money order payable to the "Hawaii State Tax Collector." Mail the return with payment to Hawaii Department of Taxation, P.O. Box 259, Honolulu, HI 96809-0259. Retain the duplicate of this return at licensed premises for verification by the Department's auditors. Return must be completed in every detail. Documentary evidence must be retained and be available to the Department of Taxation at licensed premises to support all entries on this return. Return must be signed by licensee or authorized agent. Penalty and interest for late payment: The penalty for failure to file a return on time is assessed on the tax due at a rate of 5% per month, or part of a month, up to a maximum of 25%. Interest at the rate of 2/3 of 1% per month or part of a month shall be assessed o