Arizona Form 835 - Domestic Farm Winery/domestic Microbrewery/domestic Cider Return Of Liquor Sold

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Arizona Department of Revenue
ARIZONA FORM
835
Comptroller Section
1600 W Monroe, Site Code 603
Phoenix AZ 85007
Domestic Farm Winery/Domestic
Microbrewery/Domestic Cider Return of Liquor Sold
For the Month of ________________________________________ 19 _____
This return and the tax shown is due not later than the 20th day of the month following the month for
which this return is made and delinquent if the tax is not paid within 10 days after the due date.
Licensed wholesaler - name
Liquor license no
Taxpayer ID (EIN or SSN)
Address - mailing
Address - business location
City
State
ZIP code
City
State
ZIP code
File Separate Return for Each License
Read Instructions Prior to Completing Return
A
B
C
Vinous
Malt
Cider
Gallons
Gallons
Gallons
1. Gallons sold ...............................................................................
2. Deductions - total gallons
a. Sold to Military Installations - Schedule B ............................
b. Exported from State - Schedule C .......................................
c. Sold to Arizona wholesalers - Schedule D ...........................
d. Tax paid - beverage returned ..............................................
3. Total Deductions (add lines 2a through 2d) ...............................
4. Other adjustments, gain or loss .................................................
5. Taxable gallons sold to Consumers/Arizona Retail stores ......
$.16
$.16
$.84
6. Tax Rates ..................................................................................
$
$
$
7. Tax Due .....................................................................................
8. Total Tax Due $ __________________________________
Declaration of preparer (other than taxpayer) is based on all information of
I have read this report and any attachments with it. Under penalties of perjury, I
which preparer has any knowledge.
declare that to the best of my knowledge and belief, they are correct and
Preparer's Signature
Taxpayer's/Authorized Agent's Signature
Preparer's TIN
Date
Title
Date
ADOR 20-2049 (7/96)

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