Passenger Carrier Report Form - 2003

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DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-160A
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE, FL 32399-1022
PASSENGER CARRIER REPORT
Report for CRUISE LINES
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 for a period of three years. This report and payment must be filed in
accordance with the provisions of Chapter 565, Florida Statutes, on or before the fifteenth day of the month following the month being
reported. Make remittances payable to the "Division of Alcoholic Beverages and Tobacco".
Licensee Name
Phone No.
(
)
License No.
Address
City
FL
Zip
Month Reported
20
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
COMPUTATION OF TAXES
BEER
(Malt Beverages)
$
0.06
1.
PINTS or LESS, 8oz, 12oz, 16oz
@
each
$
0.12
2.
QUARTS, 17oz to 32oz
@
each
GALLONS Bulk, Draft beer only
$
0.48
3.
@
each
4. TOTAL FOR BEER
WINE
(Vinous Beverages)
$
2.25
5.
Gallons, UNDER 17.259%
@
each
$
3.00
6.
Gallons, 17.259% or MORE
@
each
$
3.50
7.
Gallons, NATURAL SPARKLING
@
each
Gallons, CIDER
8.
@
$
0.89
each
8. TOTAL FOR WINE
LIQUOR
(Spirituous Beverages)
$
2.25
9.
Gallons, UNDER 17.259%
@
each
$
6.50
10.
Gallons, 17.259% to 55.78%
@
each
Gallons, OVER 55.78%
$
9.53
11.
@
each
12. TOTAL FOR LIQUOR
TOTAL TAX TO BE REMITTED WITH THIS REPORT
Beer 003020 - Wine 003025 - Liquor 003030
DAB&T USE ONLY
Report Receipt
In'ls
Payment Verification
In'ls
Field Review
In'ls
Central Processing
In'ls
Postmark Date
Receipt Number
Initial Review Date
Initial Receipt Date
Delivery Date
Payment Date
Amended Date
Completed Date
Delinquent Action
Excise Tax Paid
Amended Amount

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