Form Fab-103 - Food And Beverage Tax Or County Supplemental Food And Beverage Tax - 2012

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Indiana Department of Revenue
Form FAB-103
2012
State Form 44465
Food and Beverage Tax or County Supplemental Food and Beverage Tax
Revised 8/11
This packet contains Food and Beverage Tax or County Supplemental Food and Beverage Tax return(s) and a Change Form to
report address changes. Your Food and Beverage Tax returns are due thirty days after the end of each month. Make sure the
information on this page is correct and complete.
Payments must be made with U.S. funds.
Please do not include check stubs when
mailing your payments.
COUPON:012
0000016308227
FAB103
Report address changes on the Change Form. For
*970000016308227*
assistance, call (317) 233-4015 or visit:
CT LLC DBA T D ALIBIS
TD ALIBIS
7381 N SHADELAND AVE
Taxpayer ID Number: 0111916216 001 1
INDIANAPOLIS,IN 46250-2052
Filing Status: MONTHLY
/462502052815/
Corresp ID: 0000016308227
Account Number: 110723508
As you review the information in this packet, please be aware of the following:
·
Filing Frequency Status May Have Changed: The Department reviews taxpayer accounts annually. Based on these reviews, please be advised that
your filing frequency status may have changed, which can affect your due dates. To avoid penalty and interest fees, please review the 2012 due dates
printed on each of your returns.
·
Closed Business: If your business has closed, you must complete Form BC-100 and attach the required documentation. Form BC-100 is available at
or by calling (317) 615-2581.
·
Incorrect Information: If the taxpayer identification number listed on your return is not correct, contact the Department at (317) 233-4015 or online at
Do not print changes or corrections on the actual return. You may use the Change Form below to change your location or
mailing address only.
·
One Payment Per Return: To avoid crediting a payment to the wrong return, be sure to submit a separate payment for each return. Multiple returns
received with only one payment may result in you receiving a bill that may include penalty and interest.
·
No Tax Is Due: The taxpayer must file a return even when no tax is due, unless the account has been closed. If a return is not filed, the Department
will issue a tax bill to you based on the best information available.
·
Due Date: If the due date printed on your return falls on a weekend or legal holiday, the payment and return are due on the next business day.
·
Postmark: The U.S. Postal Service postmark date determines if a return is timely. Please be aware of your local postal service’s hours of mail pickup.
A payment made (postmarked or initiated by electronic funds transfer) after the due date of the return is subject to a penalty of 10 percent of the
amount due or $5, whichever is greater, plus interest.
For more information or assistance, please contact the Department at (317) 233-4015 or online at
Taxpayer ID Number
0111916216 001 1
Change Form
Do not send Change Form with return. Use separate envelope.
Mail to the Indiana Department of Revenue, P.O. Box 6197, Indianapolis, IN 46206-6197
(Please Print Clearly)
This will change your Food and Beverage or County Supplemental Food and Beverage Tax Account only.
New Location Address
New Mailing Address
DBA Name
DBA Name
Address
Address
City
City
State
ZIP Code
State
ZIP Code
Federal ID#
County
Federal ID#
County
Telephone Number
Telephone Number
F
Signature
Title
Date

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