Excise Tax Report Form For Wholesale Liquor Excise Tax - Cobb County Business License Division
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1COBB COUNTY BUSINESS LICENSE DIVISION
Attn: Liquor Taxes
P O Box 649
Marietta GA 30061
(770) 528-8410
Fax (770) 528-8414
EXCISE TAX REPORT FORM
For Wholesale Liquor Excise Tax
Name of Wholesaler______________________________________ Phone #______________
Business Address______________________________________________________________
Mailing Address_______________________________________________________________
Type of Alcoholic Beverage________________________ Report for Month of______________
I.
This report is due on or before the 20th day of each month following the month being reported.
II.
Invoices must be retained for 24 months in the event of request by authorized representatives
of Cobb County.
III. A report of amount sold for the month, a Georgia State Monthly Alcohol Report, must accompany
this report.
IV. Calculate tax due based due based on quantities of liquor sold. You may use either gallons or liters.
1. Gross quantity of liquor sold in
Unincorporated Cobb County
_________ Gallons X $.80 = $_____________
(Tax Due)
2. Gross quantity of liquor sold in
Unincorporated Cobb County
__________ Liters
X $.22 = $_____________
(Tax Due)
3. Total Due (From lines 1 and 2)
$_____________
th
4. Add Penalty (10% per month if postmarked after the 20
)
$_____________
th
5. Add Interest (1% per month if postmarked after the 20
)
$_____________
6. Total Amount Payable
$_____________
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 Notary Public
Date
Signature of Individual
Date
Preparing Report
NOTE: Please make checks payable to Cobb County Business License and mail to the above address
by the 20th of each month.
Please send UPS / FedEx packages to:
Cobb County Business License Division
1150 Powder Springs St. Suite 400
Marietta, GA 30064
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