Beverages Shipped To/within Florida Form - 2003

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DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-125-3
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE, FL 32399-1022
BEVERAGES SHIPPED TO / WITHIN FLORIDA
SPIRITUOUS BEVERAGES shipped to / within Florida during the month of
Yr
Name
Address
City
State
Zip
Telephone No. (
)
Contact Person
List each shipment and file on or before the 10th of each month to the address above, ATTN: Bureau of Auditing
UNDER
17.259% -
OVER
INVOICE
CONSIGNEE'S CITY
NAME OF CONSIGNEE
17.259%
55.78%
55.78%
LOCATION
DATE
NUMBER
GALLONS
GALLONS
GALLONS
Subtotals this page
GRAND TOTALS FOR MONTH
Proof:
17.259% by volume = 34.518 Proof
55.78% by volume = 111.56 Proof

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