Form Rl-43 - Alcoholic Liquor Permits And Purchases 1999

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Illinois Department of Revenue
Page ____ of ____
RL-43
Alcoholic Liquor Permits and Purchases
Business name __________________________________________________________
Date issued __ __ __ __ __ __ __ __
Month
Day
Year
Address _______________________________________________________________
Class of alcoholic liquors:
Class 3 (5,000 gallons)
Number and street
Class 4 (10,000 gallons)
______________________________________________________________________
Class 5 (50,000 gallons)
City
State
ZIP
NBU license no. ________________________________________
Number of gallons authorized _______________________________
Comments
Date
Number
Gallons
Balance
Invoice date
Invoice no.
Purchased from
Gallons
.
.
.
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RL-43 front (R-5/99) IL-492-1637

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