COMMISSIONERS ESTHER H. VASSAR, CHAIR PAMELA O’BERRY EVANS SUSAN R. SWECKER 2901 HERMITAGE ROAD P.O. BOX 27491 RICHMOND, VIRGINIA 23261 (804) 213-4400 FAX (804) 213-4411 TDD LOCAL (804) 213-4687 CHIEF OPERATING OFFICER/SECRETARY TO THE BOARD W. CURTIS COLEBURN, III April 21, 2006 TO: ALL APPROVED VIRGINIA ABC COMMON CARRIERS RE: MONTHLY REPORTING All approved Virginia ABC Common Carriers are required to file a monthly report on forms prescribed by the Board. The report is to be filed with the Virginia Department of Alcoholic Beverage Control, Attention: Tax Management Section, P. O. Box 27491, Richmond, Virginia 23261-7491, along with a signed copy of all invoices delivered to recipients in Virginia during the preceding month. This report shall be postmarked no later than the fifteenth of the month or, if the fifteenth is not a business day, the next business day thereafter. ABC Common Carriers shall report the quantities of wine and/or beer delivered into or within the Commonwealth. Such report shall also include the name and addresses of the purchasers to whom wine and/or beer was delivered. Board approved Common Carriers shall refuse delivery when the proposed recipient appears to be under the age of 21 years and refuses to present valid identification. Enclosed are copies of the monthly tax report forms for your use. This report may be duplicated using the same format. If you wish to make changes to these forms, please contact this office for approval before using. If you have any questions, please contact this office at (804) 213-4555 or (804) 213-4556. Sincerely, Ernestine Mack, Manager Bureau of Law Enforcement Tax Management Section /em Encl. American LegalNet, Inc. www.FormsWorkflow.com COMMONWEALTH OF VIRGINIA DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL COMMON CARRIER'S REPORT PART 1 Name Trading as A.B.C. Common Carrier No.____________________________________________________________ File this report with Virginia Department of Alcoholic Beverage Control, P O Box 27491, Richmond, Virginia, 23261-7491, along with a signed copy of all invoices delivered to recipients Address in Virginia during the preceding month. This report shall be postmarked no later than the fifteenth of the month or, if the fifteenth is not a business day, the next business day thereafter. Report for the month of Year ____________________ City or Town and State Date Shipped Invoice Name Virginia Resident Shipped To Compete Address Number _____________________________________________________________ Product Type W/ B/ C Wine or Cider Size in Total Liters Bottles Liters No. of No. of Beer Bottle Bottles Size Total Shipper's License Ounces Shipper's Name No. I swear (or affirm) that this report has been examined by me, and, to the best of my knowledge and belief, is a true and complete report made in Signed _____________________________________ good faith for the period as stated, pursuant to the ALCOHOLIC BEVERAGE CONTROL ACT and regulations of the Virginia A.B.C. Board. Date _______________________________________ American LegalNet, Inc. www.FormsWorkflow.com Virginia Resident Shipped To Date Invoice Shipped Number Report for the month of______________________ COMMONWEALTH OF VIRGINIA DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL COMMON CARRIER'S REPORT PART 2 Name Street and No. City, State & Zip Code ABC Common Carrier No.______________________ Wine or Cider Product Type W/B/C No. of Bottles Size In Liters Total Number of Wine Liters Total Liters Beer No. of Bottles Bottle Size Total Ounces Shipper's License No. Total No. of Beer Ounces Total Number of Cider Liters American LegalNet, Inc. www.FormsWorkflow.com A COPY OF ALL INVOICES MUST BE SUBMITTED WITH THIS REPORT, SIGNED BY THE RECIPIENT