Liquor Tax Report Form - Cobb County Business License Division
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1Cobb County Business License Division
Attn: Liquor Taxes
P O Box 649
Marietta, GA 30061
Phone 770-528-8410
Fax 770-528-8414
LIQUOR TAX REPORT FORM
For Liquor Package Stores
Name of Business: _________________________________________________________ License #___________________
Business Location: ____________________________________________________________________________________
Mailing Address:______________________________________________________________________________________
Phone# ____________________________________________ Report for the Month of______________________________
___________________________________________________________________________________________________
I.
This report is due no later than the twentieth day of the month following the period for which the return is being filed.
II.
Report, in writing, changes of ownership, licensee or address immediately.
III.
Prepare this report in duplicate and retain one copy.
IV.
Georgia Sales Tax Report must be attached to this form.
V.
This report must be submitted even if no taxes are due. Failure to submit report shall result in suspension and/or revocation of
license.
___________________________________________________________________________________________________
Current Month
Year to Date
1.
Total Gross Sales
$_________________
$____________________
2.
Less Exempt Sales (itemize on back)
$_________________
$____________________
3.
Taxable Liquor Sales
$_________________
$____________________
4.
Tax Due – (5% of line 3 if taxable sales, year to date, is
$_________________
$____________________
between $100,000 and $178,000)
5.
Penalty (10% of tax due for each month or fraction
$_________________
thereof following the due date until paid in full.)
6.
Interest (1% of tax due for each month or fraction thereof
$_________________
following the due date until paid in full.)
7.
Total Amount Due
$_________________
THIS REPORT MUST BE SIGNED
___________________________________________________________________________________________________
I certify that the statement made herein and any supporting documents are true, correct and complete to the best of my
knowledge.
______________________________
/______________
_______________________________________________
Signature of Individual Preparing Report / Phone Number
Signature of Licensee or Designee
Make checks payable & mail to:
Cobb County Business License
ATTN: LIQUOR TAX
P. O. Box 649
Marietta, GA 30061
Only packages sent by UPS / FedEx will be delivered packages to:
Cobb County Business License Division
1150 Powder Springs St. Suite 400
Marietta, GA 30064
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