FORM C-200 (08/18 TABC USE ONLYENTRYCHECKEDCITY:DistilledWine Not WineWine Ale /SpiritsOver 14%14% - 24%SparklingMalt Liquor1. Opening Inventory2. Receipts 3. Total (Line 1 + 2) 4. Withdrawals 5. Closing Inventory (Line 3 - 4) DistilledWine Not WineWine Ale / SpiritsOver 14%14% - 24%SparklingMalt Liquor1. Opening Inventory2. Receipts 3. Total (Line 1 + 2) 4. Withdrawals 5. Closing Inventory (Line 3 - 4) Signature Date AFFIRMATION:Underpenaltyofperjury,IswearIamanofficerorauthorizedrepresentativeoftheabovePermittee,andIhaveexamined this report, and confirm it is true, correct, and complete. TRADE NAME: ADDRESS: ZIP CODE: PHONE NUMBER: PERMIT NUMBER: J Permit Number: K For Account of: For Account of: Permit Number: K INSTRUCTIONS:Thisformandanyattachmentsmustbefiledonorbeforethe15thdayofthemonth,followingeachreportingperiod.Mailto TABC,POBOX13127,AUSTIN,TX78711-3127orsubmitelectronicallytothee-mailaddressbelow.Retainonecopyforyourfilesforaperiodoffouryears.Aslongasyourpermitremainsactive,youmustfileareportevenifnobusinesswasconducted.Forassistance,pleasecontactthe Tax Division at (512) 206-3342 or excise.tax@tabc.texas.gov Monthly Report of Receipts and Withdrawals of Liquor WAREHOUSE REPORT During the Month/Year of: GALLONS GALLONS E-Mail Address Title American LegalNet, Inc. www.FormsWorkFlow.com Distilled Wine NotWineWine Ale / SpiritsOver 14%14% - 24%SparklingMalt Liquor1. Opening Inventory2. Receipts 3. Total (Line 1 + 2) 4. Withdrawals 5. Closing Inventory (Line 3 - 4) Distilled Wine NotWineWine Ale /SpiritsOver 14%14% - 24%SparklingMalt Liquor1. Opening Inventory2. Receipts 3. Total (Line 1 + 2) 4. Withdrawals 5. Closing Inventory (Line 3 - 4) Distilled Wine NotWineWine Ale /SpiritsOver 14%14% - 24%SparklingMalt Liquor1. Opening Inventory2. Receipts 3. Total (Line 1 + 2) 4. Withdrawals 5. Closing Inventory (Line 3 - 4) GALLONS For Account of: Permit Number: K For Account of: Permit Number: K For Account of: Permit Number: K FORM C-200 (08/18) GALLONS GALLONS American LegalNet, Inc. www.FormsWorkFlow.com