Form Ltd 3 - Liquor Importer/wholesaler Monthly Report Form Of Exports - Nevada Department Of Taxation
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1NEVADA DEPARTMENT OF TAXATION
1550 E COLLEGE PARKWAY
CARSON CITY, NEVADA 89706
LIQUOR IMPORTER/WHOLESALER MONTHLY REPORT OF EXPORTS (NRS 369.370)
Excise tax credit (as shown on LTD 1) for alcoholic beverages exported from the State of Nevada into
the state of
during the month of
, 20
By the firm of
Street
City
This report must be made in duplicate monthly to the Department of Taxation for shipments into each state.
MALT BEVERAGES
ALCOHOLIC BEVERAGES
NAME AND ADDRESS WHERE
DATE
CITY
BOTTLE
KEG
GALLONS
GALLONS
GALLONS
SHIPMENT IS MADE
OR CAN
GALLONS
.5% to 14%
14.1% to 22%
22.1% to 80%
GALLONS
GALLON TOTALS:
LESS .5% FORMERLY DISCOUNTED:
TOTAL, ENTER ON LINE 3 OF TAX RETURN:
The foregoing report is true and correct to the best of my knowledge and belief.
Signed ................................ ................................ ................
Title ................................ ................................ ....................
LTD 3 (10/03)
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