FORM C-206 REGIONAL FORWARDING CENTER (11/02) TABC USE ONLY ENTRY Monthly Report of Alcoholic Beverages Received and Transferred SUMMARY During the Month/Year of: SCHEDULES TRADE NAME: CERTIFICATE NUMBER: FC RFC ADDRESS: CITY: ZIP CODE: PHONE NUMBER: SUMMARY GALLONS 1. Inventory, Beginning of Month (Prior Monthly Report, Line 5) 2. Alcoholic Beverages Received (Schedule A) 3. Total Gallons (Line 1 + 2) 4. Alcoholic Beverages Transferred (Schedule B) 5. Inventory, End of Month (Line 3 - 4) AFFIRMATION, Under penalty of perjury, I swear I am an officer or an authorized representative of the above Licensee, and I have examined this report, and confirm it is true, correct, and complete. Signature INSTRUCTIONS: Title Date Prepare the report in duplicate, mail the original to the T.A.B.C., PO Box 13127, Austin, TX 78711-3127 on or before the 15th of each month, following the month for which the report is made. Retain one copy for your files for a period of four years. As long as your certificate remains active, you must file a report even if no business was conducted. For assistance, please contact the Compliance Department at (512) 206- 3342. American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE A - RECEIPTS DATE OF INVOICE RECEIPT NUMBER POINT OF ORIGIN TRADE NAME CITY, STATE GALLONS CARRIER MAKING DELIVERY TRADE NAME PERMIT NO. TOTAL RECEIPTS (Transfer Total To Line 2 of Summary) SCHEDULE B - TRANSFERS DATE OF INVOICE TRANSFER NUMBER DESTINATION TRADE NAME CITY, STATE GALLONS CARRIER MAKING DELIVERY TRADE NAME PERMIT NO. TOTAL TRANSFERS (Transfer Total To Line 4 of Summary) NOTE: If space provided is inadequate, attach supplemental schedule(s) American LegalNet, Inc. www.FormsWorkflow.com