MARYLAND FORM 532 FAMILY BEER AND WINE FACILITY PERMIT REPORT See page 2 for complete instructions. Name of Permit Holder Permit Number FPMailing Address City State Zip Code E-mail Address For the report year For the report year October 1st - September 30th 20 BEER GALLONS 1. Produced during month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _____________ 2. Samples produced . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _____________ 3. Produced for testing equipment, recipes, etc. . . . . . . . . . . . . . . . . . . . . . . . _____________ 4. Total beer produced. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _____________ WINE 5. Produced during month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Samples produced during month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Produced for testing equipment, recipes, etc.. . . . . . . . . . . . . . . . . . . . . . . 8. Total wine produced . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AFFIDAVIT I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing document are true and correct to the best of my knowledge, information and belief. _____________ _____________ _____________ _____________ Signature of permit holder Title: Owner, Partner or Officer Type or print name of permit holder Date COM/RAD 532 04/17 American LegalNet, Inc. www.FormsWorkFlow.com MARYLAND FORM 532 FAMILY BEER AND WINE FACILITY PERMIT REPORT INSTRUCTIONS This report, together with form COM/RAD 532-1, shall be filed and physically received by the Comptroller of Maryland, Alcohol and Tobacco Tax Division no later than October 15th following the report year which it covers. Insert in the space provided the entity name and your permit number. Indicate the report year the report covers. LINE 1 2 INSTRUCTION Indicate beer produced by individuals from line 20 of the Detail Report COM/RAD 532-1 designated "Beer." Indicate beer produced for sampling from line 20 of the Detail Report COM/RAD 532-1 designated "Beer Samples." Indicate beer produced for testing equipment and recipes. Add lines 1, 2 and 3 for grand total beer produced. Indicate wine produced by individuals from line 20 of the Detail Report COM/RAD 532-1 designated "Wine." Indicate wine produced for sampling from line 20 of the Detail Report COM/RAD 532-1 designated "Wine Samples." Indicate wine produced for testing equipment and recipes. Add lines 5, 6 and 7 for grand total wine produced. Mail tax return to: Comptroller of Maryland Revenue Administration Division Alcohol Tax P.O. Box 2999 Annapolis, Maryland 21404 For more information: Telephone: 410-260-7127 or 800-638-2937 Fax: 410-260-7924 3 4 5 6 7 8 Complete form by having an officer of the company sign and date the report. COM/RAD 532 04/17 American LegalNet, Inc. www.FormsWorkFlow.com