MARYLAND FORM WHOLESALER'S REPORT OF BEER ACQUISITIONS One Supplier Per Page 037-5 Schedule Type ___________ Page _________ of _________ WHOLESALER'S PERMIT #: ______________________________________ FOR THE MONTH OF _____________ 20 ________ WHOLESALER'S NAME: ________________________________________________________ SUPPLIER ____________________________________________________ Non-Resident Dealer, Maryland Brewer or Wholesaler SUPPLIER'S LICENSE OR PERMIT #: ______________________________________________________ Foreign Supplier 1 Invoice Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 COM/RAD-037-5 2 3 4 Number/ Cases 24/7 5 Number/ Cases 24/10 6 Number/ Cases 24/11.2 7 Number/ Cases 24/12 8 Number/ Cases 24/16 9 Number/ Cases 12/32 10 11 12 13 14 15 Date Carrier � Keg � Keg 50 L Keg Total Cases/Kegs Received Multiply by Conversion Factor Total Gallons by Container Size TOTAL GALLONS THIS SUPPLIER 01/17 American LegalNet, Inc. www.FormsWorkFlow.com 1.313 1.875 2.100 2.250 3.000 3.000 7.750 15.500 13.210 MARYLAND FORM 037-5 WHOLESALER'S REPORT OF BEER ACQUISITIONS INSTRUCTIONS Page 2 This report together with Form COM/RAD-037, shall be filed and physically received by the Alcohol and Tobacco Tax office no later than the 10th day of the month following the month which it covers. Insert in the spaces provided the month, year, and company name. Allotting one COM/RAD-037-5 for each supplier, insert the name of the supplier and the supplier's license or permit number on the lines provided. In the upper right corner, label each COM/RAD-035-5 with the appropriate schedule type. Only one of the following schedule types may occupy each page: a. Schedule A-1: Acquisitions from Permit Holders Non-Resident Dealer Contact information: Comptroller of Maryland Revenue Administration Division Alcohol Tax PO BOX 2999 Annapolis, MD 21404-2999 Telephone: 410-260-7127 or 800-638-2937 Fax: 410-260-7924 b. Schedule A-2: Acquisitions from Maryland Wholesalers and Manufacturers c. Schedule A-3: Acquisitions from Foreign Suppliers d. Schedule A-4: Acquisitions from Other Sources (RADach fill explanation.) Below the schedule type, on the lines provided, consecutively number the pages within each schedule type. Below the page number, indicate whether the schedule is for a foreign supplier by placing an "X" in the box provided. Column Line 1 2 3 1-25 1-25 1-25 Insert the invoice number for each shipment. Insert the date the shipment was received. Insert the Maryland Public Transportation Permit Number of the carrier or other carrier identification as appropriate. Insert the number of cases or kegs of each size received from this supplier. Insert the total number of cases or kegs of each size received from this supplier. This line is to be used for the appropriate container-to-gallons conversion factor for each container size. Insert the grand total in gallons of beer received from this supplier. Complete only one line 30 for each supplier even if multiple sheets are used. 4-15 4-15 4-15 1-25 26 27 4-15 28 The total gallons received from each supplier should be transferred to the appropriate line on the Maryland Wholesaler's Monthly Beer Report COM/RAD-037. COM/RAD-037-5 01/17 American LegalNet, Inc. www.FormsWorkFlow.com