Michigan Department of Licensing and Regulatory Affairs MICHIGAN LIQUOR CONTROL COMMISSION (MLCC) 7150 Harris Drive, P.O. Box 30005 - Lansing, Michigan 48909-7505 MICHIGAN BEER TAX REPORT PENALTY: A licensee who fails or refuses to submit a required report, or who submits a false report, may have the license suspended or revoked. * Refer to detailed instructions on the back of this form. * 1. GENERAL INFORMATION: 2. REPORTING PERIOD: Licensee Name Month Street Address Year 3. REPORT (CHECK ONE): City, State, Zip Code Business Phone ESTIMATED Tax Report - go to box 4 License No. FINAL Tax Report - go to box 5 4. ESTIMATED TAX REPORT - File one copy of this report, along with payment, no later than the 20th of the Reporting Period Month. Estimated taxes are paid only by licensees whose average monthly tax payments for the previous calendar year were $50,000 or more. Enter amount which is ONE-HALF of what the final tax report will be: $ _______________________________ 5. MICHIGAN BEER TAX REPORT - FILE NO LATER THAN THE 15TH OF THE MONTH FOLLOWING THE REPORTING PERIOD. TAX = $6.30 per Barrel or $.0015877 per ounce Pack Size Quantity Sold Prorated Tax Rate TAX DUE Pack Size Quantity Sold Prorated Tax Rate TAX DUE 1/2 Bbl -15.5 gals. X 3.15 = $ Case -20/16.9 oz X .53664 = $ 1/4 Bbl - 7.75 gals. 1.575 $ Case -20/12 oz. .38105 $ 1/6 Bbl – 5.0 gals 1.05 $ Case -24/11.2 oz. .42678 $ Keg - 13.2 gals. 2.74355 $ Case -24/11.5 oz. .43821 $ Keg - 13.5 gals. 2.68258 $ Case -24/12 oz. .45726 $ Case - 8/40 oz. .50806 $ Case -24/16 oz. .60968 $ Case - 12/12 oz. .22863 $ Case -24/16.9 oz. .64397 $ Case – 12/22 oz. .41915 $ $ Case – 12/24 oz. .45726 $ $ Case – 12/32 oz. .60968 $ $ Case – 12/40 oz. .76210 $ $ Case – 18/12 oz. .34294 $ $ 6. PROCEDURE TO FIGURE TAXES DUE 7. VERIFICATION OF TAX REPORT A. Total Taxes Due ________________________ I declare that the information in this report is correct. B. Less Estimated Payment ________________________ C. Less - Authorized Credit _________________________ D. Plus Penalty _________________________ E. Balance Due _________________________ Make checks payable to: State of Michigan/MLCC ------------------------------------------------------------------------------------------------Signature of Authorizing Agent ----------------------------------------------------------------Title -------------------------Date CASHIER VALIDATION (Do not write in this space) LC-3803 (Rev. 07/11) AUTHORITY: MCL 436.1409 COMPLETION: Mandatory PENALTY: Fine &/or License Revocation LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities. American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS Who must file: Any Michigan brewer, micro-brewer or brewpub who manufactures beer in the State of Michigan and any out of state licensee (Out State Seller of Beer) who is authorized by the Michigan Liquor Control Commission (MLCC) to ship malt beverages into the State of Michigan. The Commission designates the brewer or person that ships the beer to a licensed wholesaler in the state as the taxpayer. When to file: Taxpayers, with the exception of brewpubs, must file monthly, FOR ALL MONTHS EVEN WHEN THERE IS NO ACTIVITY. In this instance, indicate ‘No Activity’ on the return and send it along to the MLCC. All reports and payments must be postmarked no later than the 15th of the month following the reporting period. Example: Tax reports for January must be postmarked by February 15th. Brewpubs file QUARTERLY. Tax reports for brewpubs must be postmarked by April 15th, July 15th, October 15th, and January 15th. A copy of the taxpayer’s Federal form, ATF-5130, must be attached to the Michigan Beer Tax Report each quarter. If your average monthly beer tax was $50,000 or more from the previous calendar year, you MUST submit and estimated report and payment equivalent to ½ of the estimated taxes that will be due for the reporting period. This report must be postmarked no later than the 20th of the reporting month. Out State Seller of Beer licensees must attach copies of invoices as support of the taxes due. Penalties: Any report postmarked after the 15th of the month following the reporting period, missing report, or missing tax payment will be subject to a $25 late charge and a 1% per month interest charge until the taxes are paid. ALL ITEMS REFER TO CORRESPONDING NUMBER ON THE FRONT OF FORM Box 1 Enter licensee name, business address, telephone number, and license number Box 2 Enter reporting period and year Only for licensees whose average monthly tax payments last year were $50, 000 or more: • • Box 3 Check whether report is for estimated or final tax Box 4 Enter an amount that represents a reasonable estimate of what ½ of the taxes for the reporting period are likely to be. Go to Box 7. Box 5 Locate appropriate pack size and enter total cases or barrels shipped in the column labeled ‘Quantity Sold’. Use the blank boxes for pack sizes that are not preprinted on the form. • Multiply ‘Quantity Sold’ by corresponding ‘Prorated Tax Rate’. The tax rate is $6.30 per barrel or $0.0015877 per ounce. • Enter ‘Tax Due’ as a result of the calculations above. Box 6 A.) Sum all totals in columns labeled ‘Tax Due’ and enter this amount on Line A. B.) Enter amount of estimated tax paid on Line B C.) Enter amount of any authorized credits on Line C. (Taxpayers must have Commission approval prior to taking a credit on the tax report.0 D.) Enter any penalties that you owe on Line D. E.) Subtract Lines B and C from Line A. Add Line D to this amount and enter ‘Balance Due’ on Line E. Box 7 Sign the report, enter your title, and enter today’s date. QUESTIONS? Call Sandy Konieczny at 517-322-6380 American LegalNet, Inc. www.FormsWorkFlow.com