NEVADA DEPARTMENT OF TAXATION LIQUOR EXCISE TAX RETURN TID: (10 digit Taxpayer ID# and 3 digit location #) Mail original to: Nevada Department of Taxation1550 College Parkway, Room 115Carson City, NV 89706 FOR MONTH ENDING: DUE ON OR BEFORE: If postmarked after the due date, penalty and interest will apply. If the name or address shown is incorrect, if the ownership or business location has changed, or if you are out of business, notify the Liquor Excise Tax Examiner in the Carson City District Office immediately. A Return MUST Be filed Each Month Whether or Not Liquor Is Imported/Manufactured MALT BEVERAGE ALCOHOLIC BEVERAGES OFFICE USE ONLY Postmark: Ck. No: Date: $ Initials: Keg or Draught Bottled or Canned Total Malt Beverage .5% to 14% 14.1% to 22% 22.1% to 80% 1.Total Gross Gallons *please see instructions on page 2 2.Credit: Breakage, Loss- LIQ-2 3.Credit: Exports or tax paid bymanufacturer- LIQ-3 4a. Credit: Military Sales- LIQ-4a 4b. Credit: Airline Sales- LIQ-4b 5.TOTAL DEDUCTIONS 6.TOTAL TAXABLE GALLONS 7. Tax Rates for liquor categories $ .16 per gal. $ .70 per gal. $ 1.30 per gal. $ 3.60 per gal. 8.Gross Tax (taxable gallons times tax rate) $ 9.Discount of 0.25% allowed if payment is postmarked on or before the 15th of the month following activity - 10.Adjusted Tax amount due and payable with this return $ 11.Less credits approved by the Department. Credit notification from the Department must be attached. - 1 2 . Penalty (see ins tructions for rate) For periods prior to April 1, 2007 the penalty is 10%. $ 1 3 . 0.75 % interest per month due on payments postmarked after the 20 th of the month $ 14. Add Liabilitie s established by the Departmen t $ 1 5 .Total a mou nt d ue and payable. $ 16.Total amount remitted with this return. MAKE CHECK PAYABLE TO THE NEVADA DEPARTMENT OF TAXATION $ Should corrections or adjustments be necessary on previously filed monthly returns: a.On a copy of an incorrect return, indicate if it is an 221Amended224 return.b.Draw a single line through the figure that is to be adjusted.c.Enter the correct figure either above or below the figure that is to be corrected.d.Adjust extensions for corrected totals.e.Apply appropriate Penalty and Interest.f.Include a note describing the reason for the correction.I hereby certify that this return, including all attached schedules has been examined by me and to the best of my knowledge and belief is a true, correct and complete return; that I am the Importer, Manufacturer, or Officer of the above business and duly qualified and authorized to verify this return. Reported By Signed Checked by Title Phone No -1 - American LegalNet, Inc. www.FormsWorkFlow.com LIQUOR EXCISE TAX RETURN INSTRUCTIONS Line 1 Line 2 Credit for shipments lost, stolen or damaged in transit, or damaged or spoiled on the premises less the 0.25% discount taken previously if the tax was paid prior to 1/1/09. If the tax was paid after 1/1/09 the discount will be 0.25%. List this on Form LIQ-2 and include all applicable documentation of the incident. This can be used by Manufacturers and Importers. Line 3 Credit for liquor exported and sold outside this State and/or liquor purchased from a manufacturer, rectifier, or brewer in this state less 0.25% discount taken previously if the tax was paid prior to 1/1/09. If the tax was paid after 1/1/09 the discount will be 0.25%. List on Form LIQ-3 and enclose a copy of the original invoice with this report. In state manufacturers should only use this line for exports. Line 4 Credit for liquor sold to airlines, permissible persons or to military bases less the 0.25% discount taken previously if the tax was paid prior to 1/1/09. If the tax was paid after 1/1/09 the discount will be 0.25%. List this on supplemental Form LIQ-4a or LIQ-4b and include invoices to qualifying parties. This can only be used by Importers. Line 5 Total of lines 2-4b Line 6 Subtract the quantity on line 5 from quantity on line 1 for total taxable gallons. Line 8 Multiply gallons shown on line 6 by tax rate shown on line 7 for the gross tax. Line 9 The excise tax imposed by this Chapter is due and payable on or before the 20th day of the following month. If all such taxes are paid on or before the 15th day of the following month, a discount in the amount of 0.25% of the tax shall be allowed. If tax is not paid by date due a penalty of 10% will be added, together with interest at the rate of 0.75% per month, or any fraction thereof, from the date due until paid. Line 10 Subtract the figure on line 9 from gross tax on line 8 for adjusted tax amount. Line 11 Subtract credits (attach Department notification of credit to this return). Line 12 If this return will not be submitted/postmarked and the taxes paid on or before the due date as shown on the face of this return, the amount of penalty due is based on the number of days late the payment is made per NAC 360.395. The maximum penalty amount is 10%. Number of days late Penalty Percentage Multiply by: 1 - 10 2% 0.02 11 - 15 4% 0.04 16 - 20 6% 0.06 21-30 8% 0.08 31 + 10% 0.10 Determine the number of days late the payment is, and multiply the net tax owed by the appropriate rate based on the table above. The result is the amount of penalty that should be entered. For example, the taxes were due January 31, but not paid until February 15. The number of days late is 15 so the penalty is 4%. Line 13 Effective 07/01/2011 interest rate change: To calculate interest for each month late after 7/1/2011, multiply Line 10 x 0.75% (or .0075) if postmarked after the 20th of the month following activity. To calculate interest for each month late from 07/01/1999 through 06/30/2011, multiply Line 10 x 1% or (.01) if postmarked after the 20th of the month following activity. Line 14 Add the amount of any Liability that has been established by the Department. Attach Department notification of amount due. Lien 15 The total amount due and payable with this return. ** For up-to-date information on tax issues, be sure to check our website -- http://tax.nv./ -- ** Check every January, April, July and October for Tax Notes articles. -2 - American LegalNet, Inc. www.FormsWorkFlow.com TID: (10 digit Taxpayer ID# and 3 digit location #) BEER, WINES AND LIQUORS IMPORTED INTO NEVADA, INCLUDE COPIES OF ALL INVOICES FROM SUPPLIERS WITH THIS RETURN Invoice Date Supplier222s Name Certificate of Compliance Holder Certificate Number Invoice Number Beer Gallons .5 through 14% Gallons 14.1 to 22% Gallons 22.1 to 80% Gallons Subtotal of Imports - 3 - LIQ-1a American LegalNet, Inc. www.FormsWorkFlow.com TID: (10 digit Taxpayer ID# and 3 digit location #) BEER, WINES AND LIQUORS IMPORTED INTO NEVADA, INCLUDE COPIES OF ALL INVOICES FROM SUPPLIERS WITH THIS RETURN (ENTER LIQUOR WITHDRAWN FROM BOND ON PAGE 4) Invoice Date Supplier222s Name Certificate of Compliance Holder Certificate Number. Invoice Number Beer Gallons .5 through 14% Gallons 14.1 to 22% Gallons 22.1 to 80% Gallons Subtotal Imports Plus Subtotal from page 3 Grand Total Imports. Enter on Line 1, Page 1 - 4 - LIQ-1a continued American LegalNet, Inc. www.FormsWorkFlow.com TID: (10 digit Taxpayer ID# and 3 digit location #) BEER, WINES AND LIQUORS MANUFACTURED IN NEVADA, ENTERED AND WITHDRAWN FROM BOND. INCLUDE COPIES OF ALL FEDERAL EXCISE TAX REPORTS WITH THIS RETURN. Product Name Date Entered Into Bond Beer Gallons .5 through 14% Gallons 14.1 to 22% Gallons 22.1 to 80% Gallons Total Gallons Withdrawn This Month Balance in Bond Total gallons withdrawn from bond this month If beer, wine, or spirits have also been manufactured for immediate sale, add total to LIQ-1c (page 6) otherwise this number goes on line 1 of page 1. - 5 - LIQ-1b American LegalNet, Inc. www.FormsWorkFlow.com TID: (10 digit Taxpayer ID# and 3 digit location #) BEER, WINES AND LIQUORS MANUFACTURED IN NEVADA, PACKAGED AND NOT ENTERED INTO BOND. INCLUDE COPIES OF ALL FEDERAL EXCISE TAX REPORTS WITH THIS RETURN. Date Product Name Beer Gallons .5 through 14% Gallons 14.1 to 22% Gallons 22.1 to 80% Gallons Total Gallons manufactured, not entered into bond Total Gallons withdrawn from bond (page 5) Grand Total of manufactured gallons Enter on line 1 of page