Form Bt-18 Alcoholic Beverages Tax Customs Clearance Certificate
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STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
Alcoholic Beverages Tax
Excise/Public Services Taxes Subdivision
Customs Clearance Certificate
25 Sigourney Street
Hartford CT 06106-5032
Rev. 06/01
Instructions
1.) This form is both an application for release of alcoholic beverages from customs and the customs officer’s report of such release.
2.) This application must be completed by the licensed distributor before the customs officer will release the alcoholic beverages.
3.) Withdrawals of alcoholic beverages from customs may only be made by a distributor licensed by the Department of Revenue Services.
4.) Any withdrawal of alcoholic beverages during the month listed below must be reported on the Form BT-5, Schedule A, Alcoholic Beverages Tax – Receipt of Tax
Free Purchases and Tax Free Returns, and attached to Form 0-255, Wholesale Alcoholic Beverages Tax Return, that covers the month the withdrawal was made.
5.) Each licensed distributor must keep an accurate record of all its alcoholic beverages in the bonded warehouse and copies of all customs clearance certificates.
___________________________________________________
____________________________________________________
Name of warehouse from which alcoholic beverages are being withdrawn
Name of licensed distributor withdrawing alcoholic beverages
___________________________________________________
____________________________________________________
Address
Address
Liquor Control Permit Number:
For the month of:
Bond Number
Number of
Wine Gallons
Remarks
Brand
Total Wine Gallons
Type of Alcoholic Beverages
(if any)
Containers
per Container
This will certify that the above-described alcoholic beverages were released from
customs’ custody.
Name of licensed distributor withdrawing alcoholic beverages
Name (Please print): ________________________ Title: _________________
Name (Please print): ________________________ Title: _________________
Signature: ________________________________ Date: _________________
Signature: ________________________________ Date: _________________
Authorized representative of licensed distributor
For the United States Customs Department
This form is to be made out in triplicate. One copy must be left with the customs officer, another copy must be retained in the licensed distributor’s file, and the final
copy must be filed by the distributor with Form O-255.
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