DO NOT WRITE IN THIS SPACE STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY DIVISION OF TAXATION R-2 (Rev.7-09) CONTROL SHEET BEVERAGE TAX WHOLESALER’S TAX SALES REPORT FOR PERIODS BEGINNING ON AND AFTER SEPTEMBER 1, 2009 Submit Control Sheet, all necessary schedules and an extra copy of Schedule “E” to the Division of Taxation, Revenue Processing Center, Beverage Tax, PO Box 241, Trenton, New Jersey 08646-0241. Pursuant to the provisions of Title 54 of the Revised Statutes, as amended and supplemented, __________________________________________, _________________________________________ (PRINT THE LICENSEE NAME HERE) (FEDERAL IDENTIFICATION NUMBER) __________________________________________, _________________________________________ (PRINT TRADE NAME HERE, IF ANY) (STREET ADDRESS) __________________________________________, _________________________________________ (CITY, STATE, ZIP) (COUNTY) ____________________________________________________________________________________ (PRINT MAILING ADDRESS IF DIFFERENT FROM ABOVE, SEE INSTRUCTION) the holder of_________________________________ License No.(s)_____________________________ (TYPE OF LICENSE(S) SEE INSTRUCTION) under Title 33 of the Revised Statutes, as amended, reports business transacted during the Bimonthly Period of __________________________ and _______________________, Year__________, as follows: Liquors (Alcohol) Total Wine Gals. Beer and Malt Beverages Total Gals. For full particulars see instructions Still Wines Total Wine Gals. Sparkling Vermouth Wines* Total Wine Gals. Total Wine Gals. Apple Cider* (3.2% to 7% Alcohol) Total Wine Gals. 1. Actual physical inventory beginning of reporting period 2. Purchases, withdrawals, etc. “H-1” 3. Returns accepted, “H-3 & H-4” 4. Total (Item 1 plus 2 & 3) 5. Taxable sales, etc., “D” 6. Exemption claimed per “E” 7. Sub-total (Item 5 plus 6) 8. Sales and returns per “A” 9. Total (Item 7 plus 8) 10. Actual physical inventory end of Reporting Period (Item 4 minus 9) COMPUTATION OF TAXES DUE AND PAYABLE WITH THIS REPORT 11. Tax due sales (Repeat Item 7) 12. Exemption taken per “F” 13. Balance (Item 11 minus 12) 14. Tax Credit per “H-3” 15. Net taxable sales (Item 13 minus 14) 16. Tax rates 17. Tax due (refer to worksheet) $0.12 $ $5.50 $ $0.875 $ $0.875 $ $0.15 $0.875 $ $ * Apple cider containing more than 7% alcohol to be included under Sparkling Wines. Apple Cider containing 3.2% to 7% alcohol to be included under Apple Cider. Title 54 of the Revised Statutes, as amended and supplemented, provides for a penalty based on the tax of 5% per month up to a maximum of five months for failure to submit a complete return, including schedules, by the required filing date. A separate penalty of 5% is required for late payments. Interest is computed at 3% over the prime rate on the unpaid balance. At the end of each calendar year, any tax, penalties and interest remaining due will become part of the balance on which interest is charged. In addition, a $100 penalty may be added for each month that the report is late. Tax Due (Total of Item 17) . . . . . . . . . . . . . . . . $ _____________________ Bev. Tax Cr. Memos. Nos. . . . . . . . . . . . . . . . . $ _____________________ Transmitted herewith in payment of taxes due . $ _____________________ This report shall cover two calendar months’ business from the first to the last of the two month period inclusive, and shall be signed by the licensee, or the proper officer if the licensee is a corporation or by the duly authorized agent of the licensee. The report with schedules and check or money order (no stamps) for the amount of taxes due shall be filed with the Division of Taxation, Revenue Processing Center, PO Box 241, Trenton, NJ 08646-0241, within FIFTEEN DAYS after the expiration of the period reported upon. Beverage Tax Reports shall be filed covering each bimonthly period or part of a period that a license is in force even though during the period no business is transacted under the license. (OVER) DO NOT WRITE IN THIS SPACE American LegalNet, Inc. www.FormsWorkFlow.com R-2 (Rev 7-09) Page 2 PLEASE COMPLETE ALL SECTIONS BELOW STATEMENT OF PHYSICAL INVENTORY Statement of actual inventory stored in New Jersey licensed premises or in Federal-tax-paid sections of New Jersey licensed public warehouses. Do not include any alcoholic beverages stored in United States Internal Revenue or United States Customs Warehouse under Federal bond. ACTUAL PHYSICAL INVENTORY BEGINNING OF PERIOD Beer and Malt Beverages Liquors (Alcohol) Still Wines Total Gals. Total Wine Gals. Total Wine Gals. Sparkling Wines* Vermouth Total Wine Gals. Total Wine Gals. Apple Cider* (3.2% to 7% Alcohol) Total Wine Gals. (A) On New Jersey licensed premises (B) Stored in Federal-tax-paid sections of the following New Jersey licensed public warehouses: Name and address of warehouse: ___________________________________ ___________________________________ ___________________________________ Total on hand first day of period (enter in Item “1” of the Control Sheet) . . . . . . . . . . ACTUAL PHYSICAL INVENTORY END OF PERIOD (A) On New Jersey licensed premises (B) Stored in Federal-tax-paid sections of the following New Jersey licensed public warehouses: Name and address of warehouse: ___________________________________ ___________________________________ ___________________________________ Total on hand first day of period (enter in Item “10” of the Control Sheet) . . . . . . . . . * Apple Cider containing more than 7% alcohol to be included under Sparkling Wines. Apple Cider containing 3.2% to 7% alcohol to be included under Apple Cider. REPORT CONTENTS (See Instruction) SCH. “A” . . . . . . . . . . . . __________________ SHEETS SCH. “BW” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _________________ SHEETS SCH. “D” . . . . . . . . . . . . __________________ SHEETS AFFIDAVITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _________________________ SCH. “E” . . . . . . . . . . . . __________________ SHEETS CERTIFICATES OF NON-BEVERAGE USE . . . . . _________________________ SCH. “F” . . . . . . . . . . . . __________________ SHEETS BEVERAGE TAX INVENTORY, CREDIT MEMOS _________________________ SCH. “H” . . . . . . . . . . . . __________________ SHEETS OTHER (________________________________) _________________________ I certify under the penalties provided by law, including license suspension or revocation, that this report (including any accompanying schedules and statement(s)) has been examined by me and is true, correct and complete. I also certify that I am the person authorized to certify this report. ___________________________________________________ (_______)_____________________ ____________________ PHONE SIGNATURE OF LICENSEE OR AUTHORIZED AGENT DATE ________________________________________ (_______)_________________ ________________________ ____________________ SIGNATURE OF INDIVIDUAL OR FIRM, PREPARING RETURN PHONE FEDERAL IDENTIFICATION NUMBER DATE PENALTIES FOR FAILURE TO FILE REPORT, OR FILING OF FALSE OR FRAUDULENT REPORT. Any person who shall fail to file any report required to be filed pursuant to the provisions of this title, or shall file or cause to be filed, with the Director, any false or fraudulent report or statement, or shall aid or abet another in the filing with the Director, any false or fraudulent report or statement, with the intent to defraud the State or evade the payment of any tax, penalty or interest or any part thereof, which shall be due pursuant to the provisions of this title, shall be punished in accordance with the State Tax Uniform Procedure Law, R.S. 54:48-1 et seq. American LegalNet, Inc. www.FormsWorkFlow.com