Form Bt-5 - Schedule A - Receipt Of Tax Free Purchases And Tax Free Returns - 2001 Page 2

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FORTIFIED
STILL WINES
DISTILLED
ALCOHOL AND
LIQUOR COOLER
BEER
Not Over 21% Alcohol
WINES
NAME AND ADDRESS
LIQUOR
COMPONENTS
Not Over
Wine Gallons
Over 21%
of person, firm, or corporation from
DATE
INVOICE
Wine Gallons
for Manufacturing
7% Alcohol
Produced by
Produced by
Alcohol
Convert Draft
All Other
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
Barrels
Wine Gallons
55,000 Wine Gal.
Wine Gallons
or less per year)
Total
FORM BT-5, SCHEDULE A, Back (Rev. 04/01)

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