Mixed Drink Tax Report Form - Peachtree City, Ga

City Hall

151 Willowbend Road

Peachtree City, GA 30269

Phone: 770-487-7657

Fax: 770-631-2505

MIXED DRINK TAX REPORT

Business Name:

Phone Number:

Due the 20th Day of the following

___________________

month

MONTH

Gross Receipts from Spirituous Liquor

3% Local Sales Tax Collected

Less 3% Collection Fee

(ONLY IF Submitted on time)

Total Tax Remitted

I certify under penalty of perjury that this is a true and correct report

of all spirituous liquors by the drink sold in the City of Peachtree City

during the month shown on this report.

___________________________________

Signature of Person Preparing Report

Printed Name of Person Preparing Report: ___________________________

Telephone Number of Person Preparing Report: _______________________

FOR OFFICE USE ONLY:

DATE RECEIVED___________________

RECEIPT #_________________________

INITIALS__________________________

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Parent category: Financial