Form Ab&t 4000a-105-1 - Liquor Manufacturer'S Monthly Report Page 3
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4DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION
DBPR Form AB&T
4000A-110-1
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Revised 1/99
1940 NORTH MONROE STREET, TALLAHASSEE, FL 32399-1022
LIQUOR MANUFACTURER'S MONTHLY REPORT
SPIRITS BOTTLED IN FLORIDA
Prepare in TRIPLICATE. Submit ORIGINAL and FIRST COPY to the AUDITING DISTRICT OFFICE of the DIVISION OF ALCOHOLIC BEVERAGES AND
TOBACCO. SECOND COPY is to be retained by the licensee. This report and payment must be filed in accordance with the provisions of Chapter
561, Florida Statutes, on or before the tenth day of the month following the month being reported.
License Name
Phone #
License #
Address
City
, Florida, Zip
Month Reported
, Yr.
Reporting Period
/
/
through
/
/
.
This report is true and correct to the best of my knowledge and belief and is submitted under penalty of perjury.
Typed Or Printed Name
Authorized Signature
SUMMARY OF TRANSACTIONS
GALLONS
GALLONS
GALLONS
UNDER 17.259%
17.259% - 55.78%
OVER 55.78%
1. BEGINNING BALANCE
2.
PRODUCED
3. RETURNED TO STOCK
4.
5. TOTAL TO ACCOUNT FOR
6. SOLD IN STATE
7. SOLD OUT OF STATE
8. BREAKAGE
9.
REPROCESSED
10. DESTROYED
11.
12. TOTAL ACCOUNTED FOR
13. ENDING BALANCE
14. INVENTORY (ACTUAL)
OVER/SHORT
15.
DAB&T USE ONLY
CENTRAL PROCESSING
REPORT RECEIPT
In'ls
FIELD REVIEW
In'ls
In'ls
Postmark Date
Initial Review Date
Initial Receipt Date
Delivery Date
Amended Date
Completed Date
Delinquency Action
Amended Amount
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