MISSOURI DEPARTMENT OF PUBLIC SAFETY DIVISION OF ALCOHOL AND TOBACCO CONTROL MANUFACTURER MONTHLY REPORT OF INVENTORY MONTH YEAR MANUFACTURER OR DOMESTIC WINERY NAME (AS LICENSED WITH MISSOURI) MISSOURI LICENSE NO. STREET ADDRESS STATE CITY ZIP The original of this report must be postmarked to the Division of Alcohol and Tobacco Control, Jefferson City, Missouri not later than the 15th of each month. Duplicate copy to be retained for your files. Copies of all invoices must be submitted with this form. SECTION A WINE ALCOHOL GALLONS SPIRITUOUS ALCOHOL GALLONS LINE 1. Untaxed Bulk Spirituous and/or Wine on Hand First of Month 2. Untaxed Bulk Spirituous and/or Wine Produced/Received During Month 3. Untaxed Bulk Removed for Bottling and/or Loss Enter as Item 1 on Form MANU Enter as Item 1 on Form MANU Enter as Item 2 on Form MANU Enter as Item 2 on Form MANU 4. Untaxed Bottled Spirituous and/or Wine on Hand First of Month 5. Untaxed Spirituous and/or Wine Bottled During Month 6. Bottled Spirituous and/or Wine Sold During Month (in gallons) SECTION B - ALCOHOL LIQUORS RECEIVED UNTAXED REPORT BOTTLED PRODUCT ONLY THAT WAS RECEIVED FROM A CONTRACTED BOTTLER. REPORT IN (WINE/SPIRIT) GALLONS PURCHASED FROM NAME ADDRESS LINE INVOICE NUMBER AND DATE SPIRITUOUS LIQUOR REMARKS WINES STATE REASON FOR RECEIVING UNTAXED Name Inv.# Addr. Inv.Date Name Inv.# Addr. Inv.Date Name Inv.# Addr. Inv.Date Name Inv.# Addr. Inv.Date Name Inv.# Addr. Inv.Date Name Inv.# Addr. Inv.Date Name Inv.# Addr. Inv.Date Enter as Item 3 on Form MANU Enter as item 3 on Form MANU 7. TOTAL ALCOHOLIC LIQUOR RECEIVED UNTAXED PAGE 1 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com SECTION C - REPORT OF CLAIMS FOR TAX EXEMPTION Manufacturer reports in this section all claims for tax exemption due to out of state sales, breakage, on premise tastings, and family use. A report of wine shipped on each outstate shipment must accompany report. Supporting data on breakage, on premise tasting, etc. must be kept on file in your office for review by our auditors. REPORT IN (WINE/SPIRIT) GALLONS LINE 8 SOLD TO NAME AND ADDRESS Name: Addr. Name: Addr. Name: Addr. Name: Addr. Name: Addr. Name: Addr. Name: Addr. Name: Addr. Name: Addr. INVOICE NUMBER AND DATE Inv.# Inv.Date Inv.# Inv.Date Inv.# Inv.Date Inv.# Inv.Date Inv.# Inv.Date Inv.# Inv.Date Inv.# Inv.Date Inv.# Inv.Date Inv.# Inv.Date TOTAL DEDUCTIONS FOR TAX EXEMPTION SPIRITUOUS LIQUOR WINE Enter as Item 6 on Form MANU Enter as Item 6 on Form MANU SECTION D - SALES TO WHOLESALE DEALERS WHOLESALER WHOLESALER NAME INVOICE NUMBER MO. LICENSE NO. WHOLESALER CITY AND DATE Name: Inv.# City: Inv.Date Name: Inv.# City: Inv.Date Name: Inv.# City: Inv.Date Name: Inv.# City: Inv.Date Name: Inv.# City: Inv.Date Name: Inv.# City: Inv.Date Name: Inv.# City: Inv.Date Name: Inv.# City: Inv.Date Name: Inv.# City: Inv.Date Name: Inv.# City: Inv.Date EXPLANATION STATE REASON FOR EXEMPTION WINE GALLONS SPIRITS WINES TOTAL SALES TO WHOLESALE DEALERS PAGE 2 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com