Form Att-123 - Wholesale Distributions Malt Beverage Monthly Report
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Clear
Georgia Department of Revenue
th
ATT-123 (REV 2/2011)
Due By the 20
of Each Month
WHOLESALE DISTRIBUTORS MALT BEVERAGE MONTHLY REPORT
WHOLESALE DISTRIBUTOR
S
T
A
T
E
L
C I
E
N
S
E
N
O
.
F
O
R
C
A
L
E
N
D
A
R
M
O
N
T
H
O
: F
20
January
2006
ADDRESS
STREET
C
T I
Y
S
T
A
T
E
Z
P I
C
O
D
E
REPORT IN NUMBER OF CASES OR KEGS ACCORDING TO PACKAGING AND SIZE OF CONTAINER
SUMMARY
(A) Gallon
(B) 1/8 Barrel
(C) 1/6 Barrel
(D) 1/4 Barrel
(E) 1/2 Barrel
(F) BBL
st
1.
Inventory 1
day of month
0
0
0
0
0
0
(Line 10, Previous Monthly Report)
2.
Purchases from brewers during month
0
0
0
0
0
0
(Total Schedule A)
3.
Purchases from other Ga.
wholesalers during month (Total
0
0
0
0
0
0
Schedule B)
4.
Total possessed this month
0
0
0
0
0
0
(Total Lines 1 through 3)
5.
Sales to other Ga. wholesalers during
0
0
0
0
0
0
month (Total Schedule C)
6.
Sales to military installations during
0
0
0
0
0
0
month (Total Schedule D)
7.
Sales to dealers and employees
0
0
0
0
0
0
during month (Total Schedule E)
8.
Additional Dispositions
0
0
0
0
0
0
(Total Schedule F)
9.
Total disposal during month
0
0
0
0
0
0
(Total Lines 5 through 8)
10.
Physical inventory—last day of month
0
0
0
0
0
0
11.
Disposal and Inventory
0
0
0
0
0
0
(Total Lines 9 and10)
12.
Difference , if any (+ or -), between
0
0
0
0
0
0
Lines 4 and 11
13.
Total taxable
(Total Lines 9 and 12, less Lines 3
0
0
0
0
0
0
and 6)
$0.48
$1.30
$1.67
$2.50
$5.00
$10.00
14.
Ga. Excise Tax rate per gallon
15.
Tax due by size
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
(Line 13 X Line 14)
16.
Gross Tax Due
$0.00
(Total of all columns in Line 15)
SUBMIT REPORT AND REMITTANCE TO:
17.
Less attached credit memorandums
issued by Ga. Department of
$0.00
GEORGIA DEPARTMENT OF REVENUE
Revenue
PO BOX 105458
18.
Net Tax Due
$0.00
ATLANTA, GA 30374-5458
(Line 16 less Line 17)
AFFIDAVIT
I hereby certify, under penalty of law, that this is a true and correct report including supporting schedules and documents, of the
malt beverage transactions during the month shown above.
SIGNED _________________________________
TITLE
_____________________________
(Owner, Officer, or General Manager)
Subscribed and sworn to before me this _____ day of _________________________
, 20___________
__________________________________________________________________
(
N
o
a t
y r
P
u
i l b
) c
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