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Form Liq-4a - Liquor Wholesaler Monthly Report Of Military Sales - Nevada Department Of Taxation

NEVADA DEPARTMENT OF TAXATION

TID # ______________________________________

1550 COLLEGE PARKWAY, STE. 115

(Enter the 10 digit Taxpayer ID# followed by the 3 digit location #)

CARSON CITY, NEVADA 89706

For the Month of ________________________

LIQUOR WHOLESALER MONTHLY REPORT OF MILITARY SALES

Firm Name

Street

City

State

Zip Code

Excise tax credit (Line 4a on LIQ-1) for alcoholic beverages sold to MILITARY UNITS in Nevada, who qualify

as “Instrumentalities of the Armed Forces of the United States”

(NRS 369.335)

Attach copies of all supporting invoices.

MALT BEVERAGES

ALCOHOLIC BEVERAGES

BOTTLE

BASE, POST, STORE,

KEG

GALLONS

OR CAN

DATE

NAME AND LOCATION SHIPPED TO

14.1% to 22%

22.1% to 80%

INSTALLATION

GALLONS

.5% to 14%

GALLONS

GALLON TOTALS:

LESS .5% FORMERLY DISCOUNTED:

TOTAL, ENTER ON LINE 4a OF TAX RETURN:

The information above is true and correct to the best of my knowledge and belief.

Signed ...........................................................................................

Title ...............................................................................................

Date……………………………………..

LIQ-4a (05/07)

SUPPLEMENTAL PAGE TO LIQ-1

Form Liq-4a - Liquor Wholesaler Monthly Report Of Military Sales - Nevada Department Of Taxation