Form Bt-5 - Schedule A - Receipt Of Tax Free Purchases And Tax Free Returns - 2001

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Form BT-5
STATE OF CONNECTICUT
Schedule A
DEPARTMENT OF REVENUE SERVICES
PO Box 5034
Alcoholic Beverages Tax
Hartford CT 06102-5034
Receipt of Tax Free Purchases and Tax Free Returns
Rev. 04/01
For the month of ________________________ , _____
Name of Distributor: ____________________________________________
Address: ________________________________________
1. Use this schedule when completing Form O-255, Wholesale Alcoholic Beverages Tax Return .
2. Use this schedule to report all purchases made during the month listed above on which alcoholic beverages tax was not paid.
3. Use this schedule to report those alcoholic beverages that were returned to you for credit and on which alcoholic beverages tax was not paid. Mark all such items with
an asterisk (*).
4. Use this schedule to report the total withdrawals from bonded warehouses for the month listed above. Please list the total for each warehouse separately.
5. Use Form BT-5A, Schedule A1, In Transit Items , to report in transit items (for example, items purchased during the month that have not been received).
STILL WINES
DISTILLED
FORTIFIED
ALCOHOL AND
LIQUOR COOLER
BEER
Not Over 21% Alcohol
NAME AND ADDRESS
LIQUOR
WINES
COMPONENTS
Not Over
Wine Gallons
of person, firm, or corporation from
DATE
INVOICE
Over 21%
Wine Gallons
for Manufacturing
7% Alcohol
Produced by
Produced by
Convert Draft
All Other
Alcohol
whom alcoholic beverages were
RECEIVED
NUMBER
Wineries That
Small Wineries
Proof Gallons
Wine Gallons
and SPARKLING
Size to bbls.
Containers
Are Not Small
(Producing
received or returned
WINES
Wineries
55,000 Wine Gal.
Barrels
Wine Gallons
or less per year)
Wine Gallons

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