Form Ab&t - Alcoholic Beverage Surcharge Report - Department Of Business And Professional Regulation

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DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
DBPR Form AB&T
4000A-005T
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 1/04
1940 NORTH MONROE STREET • TALLAHASSEE, FL 32399-1022
ALCOHOLIC BEVERAGE SURCHARGE REPORT
TEMPORARY FORM
(To be used only until receipt of Surcharge Payment Coupon Booklet)
Alcoholic Beverage License No.
Report for the Month of
Year
Licensees reporting on the
“Purchases” method are
“Gallons” (Sales Method), or
Check the
Licensee Name
Telephone No.
(
)
allowed to take a calculated
“Adjusted Gallons”
method of
deduction to compensate for
(Purchases Method) is
calculating and
spillages. (“Sales” method
multiplied by the “Tax Rate
Address
City
State
Zip
reporting
licensees report gallons actually
per Gallon” to obtain
surcharge.
Total gallons per
sold, thus automatically getting
GROSS SURCHARGE.
category are transferred
credit for any spillage that has
This report is true and correct to the best of my knowledge and belief and is submitted under penalty of perjury.
from the CONVERSION
occurred.)
TO GALLONS
WORKSHEET.
Typed or Printed Name
Authorized Signature
TAX COMPUTATION WORKSHEET
THIS SECTION IS ONLY FOR USE BY LICENSEES
REPORTING UNDER THE PURCHASES METHOD
GALLONS
GROSS SURCHARGE
(to be forwarded to boxes below)
Spillage Allowance
Adjusted Gallons
10%
$
0.14
DRAFT BEER
less
spillage
at
per gallon
5%
$
0.14
BEER
less
spillage
at
per gallon
5%
$
0.14
COOLERS
less 5% spillage spillage
at
per gallon
5%
$
0.21
CIDER
less 5% spillage spillage
at
per gallon
5%
$
1.07
WINE
less 5% spillage spillage
at
per gallon
10%
$
4.28
LIQUOR
less 10% spillage
spillage
at
per gallon
Gross Surcharge for each
Gross Surcharge for each
category of beverage is
category of beverage is
calculated on the TAX
transferred to the
DRAFT BEER Surcharge Due
COMPUTATION
Surcharge Due section.
WORKSHEET and then
+BEER Surcharge Due
transferred to the ALCOHOLIC
+COOLERS Surcharge Due
+CIDER Surcharge Due
A 1% Collection Allowance is
+WINE Surcharge Due
given if the report is submitted
and the surcharges paid by the
+LIQUOR Surcharge Due
due date (the 15th of the
following month).
DABT USE ONLY
=GROSS SURCHARGE DUE
-Less: Collection Allowance
Check Number:
-Less: Authorized Credit
Check Amount:
=NET AMOUNT DUE with RETURN
Report paid by EFT:
Surcharge credit that has been issued by
the Division of Alcoholic Beverages and
Tobacco may be deducted.

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