Form R-12 - Beverage Tax - Schedule "H"
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2R-12 (8-97, Rev. 4)
STATE OF NEW JERSEY
SHEET No. __________ of __________
DEPARTMENT OF THE TREASURY
DIVISION OF TAXATION
SCHEDULE “H”
BEVERAGE TAX
Alcohol and alcoholic beverages received during the bimonthly period of _______________________ and ________________________, year ________
by ________________________________________________________ License No. _______________________
(NAME OF LICENSEE)
Beer and Malt
Liquors
Sparkling
Apple Cider *
Still
List name and address of seller
(3.2% to 7%
Beverages
(Alcohol)
Vermouth
Wines *
Wines
(and of shipper if other than the seller,
Alcohol)
warehouse and transporter).
Total Gallons
Total Gallons
Total Gallons
Total Gallons
Total Gallons
Total Gallons
H-1
List under separate headings by accounts gross quantities of beverages received.
(ATTACH ADDITIONAL SHEETS IF NECESSARY)
H-2
List by accounts all beverages in transit at the end of the period.
* Apple cider containing more than 7% alcohol to be included under “Sparkling Wines”. Apple cider containing 3.2% to 7% alcohol to
be included under “Apple Cider”.
(ATTACH ADDITIONAL SHEETS IF NECESSARY)
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Parent category: Financial