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Form Att-148 - Carriers Monthly Report Of Alcoholic Beverage Shipments Delivered In The State Of Georgia

ATT-148 (REV 3/03)

Department of Revenue

Alcohol & Tobacco Division

Audit and Regulatory Section

P.O. Box 49728

Atlanta, GA 30359

Telephone: (404) 417-4870

Fax: (404) 417-4871

CARRIERS MONTHLY REPORT OF ALCOHOLIC BEVERAGE

SHIPMENTS DELIVERED IN THE STATE OF GEORGIA

Affidavit for the Month of ______________________________ 20_____

NAME OF CARRIER

STREET ADDRESS

CITY

STATE

ZIP CODE

IMPORTANT INSTRUCTIONS

THIS AFFIDAVIT MUST BE FILED WITH THE GEORGIA DEPARTMENT OF REVENUE ON OR BEFORE THE

15TH OF EACH CALENDAR MONTH, COVERING ALL ALCOHOLIC BEVERAGE SHIPMENT DELIVERED IN THE

STATE OF GEORGIA DURING THE PRECEDING CALENDAR MONTH.

THIS AFFIDAVIT MUST BE ACCOMPANIED BY COPIES OF ALL BILLS OF LADING FOR THESE SHIPMENTS.

AFFIDAVIT

BEFORE ME, AN OFFICER AUTHORIZED BY LAW TO ADMINISTER OATHS, PERSONALLY

APPEARED

AN AUTHORIZED AGENT OF THE ABOVE NAMED BUSINESS, WHO FIRST BEING DULY SWORN DEPOSES

AND SAYS THAT THE ATTACHED COPIES OF BILLS OF LADING ARE TRUE AND CORRECT COPIES OF ALL

BILLS OF LADING COVERING ALL DELIVERIES OF ALCOHOLIC BEVERAGES IN THE STATE OF GEORGIA

MADE DURING THE PRECEDING MONTH, AND ARE SUBMITTED IN ACCORDANCE WITH GEORGIA

ALCOHOLIC BEVERAGE CODE.

SUBSCRIBED AND SWORN TO BEFORE ME

THIS ______ DAY OF ___________________, _________

SIGNED___________________________________

________________________________________________

Authorized Agent

Notary Public

An Equal Opportunity Employer

Form Att-148 - Carriers Monthly Report Of Alcoholic Beverage Shipments Delivered In The State Of Georgia