Alcoholic Beverage By The Drink Excise Tax Return Form - Department Of Finance Internal Audit & Licensing
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1DeKalb County
330 W. Ponce De Leon Ave.
2nd Floor
Decatur, Georgia 30031
(404) 371-2772
Department of Finance
Fax (404) 371-2946
Internal Audit & Licensing
ALCOHOLIC BEVERAGE BY THE DRINK EXCISE TAX RETURN
Business Name:
Account Number:
Address:
Month/Year Reported:
A. Inventory - Liquor Reporting Only -
B. Excise Tax Reporting
List your inventory purchases from
Licensed Wholesalers for the month
1 Gross Liquor Sales by the Drink
1 Atlanta Whls.
Liters
2 Tax - 3% times Line 1
2 Empire Distr.
Liters
3 Less Collection Fee - 3% of
Line 2 (Only on Timely Returns)
3 General Whls.
Liters
4 Credit or Debit
4 Georgia Crown
Liters
5 Penalty - 10% times Line 2 -
5 National Distr.
Liters
25% fraud or intent to eveade
6 United Distr.
Liters
6 Interest - 1% per month or
portion thereof time Line 2
7
Liters
7 Total Amount Due
$
8
Total Liters Purchased
8 Total Amount Paid
$
Total Cost of Liquor Purchased
$
9
This return and payment of the taxes collected during the month shown are due by the 20th day
of the next month to avoid a late payment penalty and interest charges.
I hereby certify that the statements made herein and on any supporting documents are true, correct and
complete to the best of my knowledge.
Print Name of Preparer
Signature of Preparer
Date
PLEASE MAKE A COPY FOR YOUR FILE AND RETURN THE ORIGINAL WITH YOUR PAYMENT.
Note:
Incomplete forms will be returned to you to be fully completed.
Mail to: P.O. Box 100020
Make check payable to:
Decatur, Ga. 30031-7020
DeKalb County Revenue and License
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