Fab-103 - Food And Beverage Tax
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2Food and Beverage Tax
FAB-103
0915
State Form 44465
.
,
,
.
Total Sales of Food & Beverages (Do Not Include Tax) .A.
s
s
s
Authorized
F
,
,
Signature _________________________________
Total Exempt Food & Beverage Sales ........................... B.
.
s
s
s
I declare under penalties of perjury that this is a true, correct
,
,
and complete voucher.
.
Net Taxable Sales (Subtract Line B from Line A) ...........C.
s
s
s
,
,
Date: ___________ Phone: __________________
.
Tax Due (
of Line C)....................................................D.
s
s
s
,
,
Collection Allowance (.73% of Line D)
Does Not Apply
Do Not Use this Line if the Payment is Late. .................. E.
.
Taxpayer ID Number
For Tax Period
s
s
s
,
,
.
Net Tax Due (Subtract Line E from Line D) .....................F.
s
s
s
Due on or Before
,
,
Penalty is Greater of $5 or 10% of Line F (Plus Interest)*
Does Not Apply
.
□
Use this line only if return is filed late. ...........................G.
.
s
s
s
,
,
Check if Amended
County/Town
Adjustments (An explanation must be attached) ............H.
s
s
s
.
,
,
Amount Due (Total Lines F and G plus or minus H) ........ I.
s
s
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 6030
INDIANAPOLIS, IN 46206-6030
Food and Beverage Tax
FAB-103
0915
State Form 44465
.
,
,
.
Total Sales of Food & Beverages (Do Not Include Tax) .A.
s
s
s
Authorized
F
,
,
Signature _________________________________
.
Total Exempt Food & Beverage Sales ........................... B.
s
s
s
I declare under penalties of perjury that this is a true, correct
,
,
and complete voucher.
.
Net Taxable Sales (Subtract Line B from Line A) ...........C.
s
s
s
,
,
Date: ___________ Phone: __________________
.
s
s
Tax Due (
of Line C)....................................................D.
s
,
,
Collection Allowance (.73% of Line D)
Does Not Apply
Do Not Use this Line if the Payment is Late. .................. E.
.
Taxpayer ID Number
For Tax Period
s
s
s
,
,
.
Net Tax Due (Subtract Line E from Line D) .....................F.
s
s
s
Due on or Before
,
,
Penalty is Greater of $5 or 10% of Line F (Plus Interest)*
Does Not Apply
.
□
Use this line only if return is filed late. ...........................G.
s
s
s
.
,
,
Check if Amended
County/Town
Adjustments (An explanation must be attached) ............H.
s
s
s
.
,
,
Amount Due (Total Lines F and G plus or minus H) ........ I.
s
s
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 6030
INDIANAPOLIS, IN 46206-6030
Food and Beverage Tax
FAB-103
0915
State Form 44465
.
,
,
.
s
s
s
Total Sales of Food & Beverages (Do Not Include Tax) .A.
Authorized
F
,
,
Signature _________________________________
.
s
s
s
Total Exempt Food & Beverage Sales ........................... B.
I declare under penalties of perjury that this is a true, correct
,
,
and complete voucher.
.
s
s
s
Net Taxable Sales (Subtract Line B from Line A) ...........C.
,
,
Date: ___________ Phone: __________________
.
s
s
s
Tax Due (
of Line C)....................................................D.
,
,
Collection Allowance (.73% of Line D)
Does Not Apply
.
s
Taxpayer ID Number
For Tax Period
Do Not Use this Line if the Payment is Late. .................. E.
s
s
,
,
.
s
s
s
Net Tax Due (Subtract Line E from Line D) .....................F.
Due on or Before
,
,
Penalty is Greater of $5 or 10% of Line F (Plus Interest)*
Does Not Apply
.
□
s
s
s
.
Use this line only if return is filed late. ...........................G.
,
,
Check if Amended
County/Town
s
s
s
Adjustments (An explanation must be attached) ............H.
.
,
,
Amount Due (Total Lines F and G plus or minus H) ........ I.
s
s
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 6030
INDIANAPOLIS, IN 46206-6030
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