Arizona Form 815 - Wholesaler'S Return Of Spirits Sold/vinous And Malt/cider Liquor Purchased
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4ARIZONA FORM
Wholesaler’s Return of Spirits Sold/
815
Vinous and Malt/Cider Liquor Purchased
th
This return and the tax shown is due not later than the 20
day of the month for which this return is made
and is delinquent if the tax is not paid within ten (10) days after the due date.
LIQUOR LICENSE NO.
TAXPAYER ID (EIN OR SSN)
FOR THE MONTH OF
, 20
LEGAL BUSINESS NAME
BUSINESS (OR DBA) NAME
MAILING ADDRESS
ADDRESS OF BUSINESS LOCATION
Check if new.
Check if new.
CITY
STATE
ZIP
CITY
STATE
ZIP
NAME OF CONTACT PERSON
TELEPHONE NUMBER WITH AREA CODE
(
)
Check if new.
Check if new.
E-MAIL ADDRESS
FAX NUMBER WITH AREA CODE
(
)
Check if new.
Check if new.
File a separate return for each license. Read instructions beginning on page 5 prior to completing the return.
(a)
(b)
(c)
SPIRITS
VINOUS
MALT/CIDER
No. of Gallons
No. of Gallons
No. of Gallons
1. Beginning Inventory (same as ending inventory of
prior month)............................................................................
2. Additions – total gallons:
a. Received/purchased this month - from Schedule A ..........
b. Returned from retailers .....................................................
3. TOTAL ADDITIONS (Add lines 2a and 2b) ............................
4. Deductions – total gallons:
a. Sold to military installations – from Schedule B ................
b. Exported from Arizona – from Schedule C........................
c. Sold to Arizona wholesalers – from Schedule D ...............
d. Purchased from Arizona wholesalers – from Schedule D.
e. Destroyed..........................................................................
f. Breakage...........................................................................
g. Returned to suppliers........................................................
h. Returned from retailers .....................................................
5. TOTAL DEDUCTIONS (Add lines 4a through 4h)..................
6. Other Adjustments – gain or loss...........................................
7. Ending Inventory....................................................................
8. Taxable gallons sold/purchased.........................................
$
3.00
$
0.84
$
0.16
9. Tax Rates ..............................................................................
$
$
$
10. Tax Due (Multiply line 8 by line 9)..........................................
$
11. TOTAL TAX DUE: (Add line 10, columns a, b, and c) ...............................................................................................................
Declaration of preparer (other than taxpayer) is based on all
I have read this report and any attachments with it. Under penalties of
information of which preparer has any knowledge.
perjury, I declare that to the best of my knowledge and belief, they are
correct and complete.
PREPARER’S SIGNATURE
TAXPAYER’S OR AUTHORIZED AGENT’S SIGNATURE
PREPARER’S TIN
DATE
TITLE
DATE
Please mail to:
Arizona Department of Revenue, Liquor Tax, 1600 West Monroe, Phoenix, AZ 85007
ADOR 14-2048 (2/04)
Previous ADOR 20-2048
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