PAGE 1 FORM C-233 (0/)TABC USE ONLYENTRYREG #SUMMARYTRADE NAME:PERMIT NUMBER:ADDRESS:CITY:ZIP CODE:PHONE NUMBER: Summary of Taxes Due 1.Inventory, Beginning of Month (Line 4 on Prior Monthly Report) 2.Malt Liquor Received (Page 2, Line 1) 3.Total (Line 1 + 2) 4.Inventory, End of Month 5.Exemptions (Page 2, Line 2) 6.Total (Line 4 + 5) 7.Malt Liquor Subject to Tax (Line 3 - 6) 8.Tax Rate Per Gallon9.GROSS TAXES DUE (Line 7 x 8) 10.LESS 2% (If payment is received by due date) 11.LESS AUTHORIZED CREDITS (Attach letter of authorization) 12.TAXES DUE STATE SignatureE-Mail Title Date TEXAS WHOLESALER REPORT Monthly Report of Ale and Malt Liquor Reporting Period: INSTRUCTIONS:Preparethereportinduplicate,mailtheoriginaltotheT.A.B.C.,POBox13127,Austin,TX78711-3127.Reportmust befiledonorbeforethe15thdayofthemonthfollowingeachreportingperiod.Retainonecopyforyourfilesforaperiodoffouryears.Aslongasyourpermitremainsactive,youmustfileareportevenifnobusinesswasconducted.Reportmaltliquorintermsofgallonsroundedofftotheseconddecimalplace.Forassistance,pleasecontacttheExciseTaxDepartmentat(512)206-3342or excise.tax@tabc.texas.gov . AFFIRMATION,Underpenaltyofperjury,IswearIamanofficeroranauthorizedrepresentativeoftheabovePermittee,andIhaveexamined this report, and confirm it is true, correct, and complete. $$**REPORT IS DUE ON OR BEFORE THE 15TH DAY OF THE MONTH FOLLOWING EACH REPORTING PERIOD** GALLONS (rounded off to the second decimal place) Thefollowingboxmustbecheckedifthepermitteedidnotpurchase,sell,orpossessDistilledSpiritsandWine. Other wise, Form C-210 must be filed. $ $0.198 $ American LegalNet, Inc. www.FormsWorkFlow.com TEXAS ALCOHOLIC BEVERAGE COMMISSIONPAGE 2 FORM C-233 (03/09) INVOICEINVOICE SUPPLIER'SCITY /GALLONSCARRIER MAKINGDATENUMBERTRADE NAMESTATE(rounded off to the second decimal place)DELIVERY MALT LIQUOR RECEIVED - Schedule A (retain invoices for audit purposes) 1. TOTAL RECEIVED (To Line 2, Page 1) MALT LIQUOR DISPOSED OF: SALES TO TEXAS DISTRIBUTORS - Schedule B (invoices must be submitted to support each entry) 2. TOTAL EXEMPTIONS (To Line 5, Page 1) NOTE: The spaces provided above for Schedules B,C,D and E should reflect monthly totals only. If more than one entry per schedule is needed, attach a supplemental schedule(s). SALES TO MILITARY INSTALLATIONS - Schedule C (retain invoices for audit purposes) EXPORTS OUT-OF-STATE - Schedule D (retain invoices for audit purposes) CARRIER CLAIMS & DESTRUCTIONS - Schedule E (documents must be submitted to support each entry) American LegalNet, Inc. www.FormsWorkFlow.com BRAND NAME(alphabetically)1/2 bbl1/4 bbl24/12 can24/12 btl TOTAL SUMMARY OF MALT LIQUOR BRANDS AND PACKAGE SIZES SUBJECT TO TAX (sales to retailers) PACKAGE SIZES TEXAS ALCOHOLIC BEVERAGE COMMISSION PERMIT NUMBER: TRADE NAME: MONTH/YEAR: American LegalNet, Inc. www.FormsWorkFlow.com