Liquor By The Drink Excise Tax Return printable pdf download

Liquor By The Drink Excise Tax Return

CHATHAM COUNTY, GEORGIA

LIQUOR BY THE DRINK

EXCISE TAX RETURN

BUSINESS NAME:

____________________________________________________________

BUSINESS ADDRESS:

____________________________________________________________

COUNTY ALCOHOL LICENSE NUMBER:

__________________________________________

GEORGIA SALES TAX NUMBER:

__________________________________________

REPORT FOR MONTH OF:

__________________________

YEAR:

____________

THIS RETURN IS SUBJECT TO AUDIT

Gross sales of liquor by the drink:

_________________

Tax (3% of line #1):

_________________

Penalty if delinquent: (add 3% or $5 whichever is greater) $

_________________

Total amount due: (Please attach check to return)

_________________

PAYMENT MUST BE RECEIVED IN THE

CHATHAM COUNTY FINANCE DEPARTMENT

BY THE 20

DAY OF THE MONTH FOR THE PRECEDING MONTH

I declare under penalties prescribed that the information provided in this return is true and correct to the

best of my knowledge and belief.

Print Name:

__________________________________

Signed:

__________________________________

Title: ________________________

Date:

_____________________________

Phone Number: ________________________

Return this form together with check for the amount shown on line 4.

Check should be made payable to: Chatham County Finance Department and mailed to:

P.O. Box 9297, Savannah, Georgia 31412. Phone # (912) 652-7900.

Liquor By The Drink Excise Tax Return