Form Rl-53 - Deliveries Of Alcoholic Liquors From Public Warehouse
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Illinois Department of Revenue
Page ____ of ____
RL-53
Deliveries of Alcoholic Liquors from Public Warehouse
Step 1: Identify your warehouse and the account for whom you store alcoholic liquors
Warehouse name ________________________________________
Reporting period:__ __/__ __ __ __
Month
Year
Street address ___________________________________________
City, State, ZIP ___________________________________________
Class of alcoholic liquor:
cider 0.5% to 7% or beer
License no.: WH-__ __ __ __ __ Account ID: __ __ __ __ __ __ __ __
alcoholic liquors 14% or less
(Check only one class per page.)
alcoholic liquors > 14% and < 20%
Account you store liquors for _______________________________
alcoholic liquors 20% or more
Street address __________________________________________
City, State, ZIP __________________________________________
Step 2: Write the total number of units you delivered
Units
50 ml
187 ml 200 ml 355 ml 375 ml 500 ml 750 ml 1.0 liter 1.5 liter 1.75 liter 4 liter
Misc.
Date delivered:
____/____/______
______
______
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______
______
______
______
______
______ ______
Name: _______________________
City: _
_______________________
Date delivered:
____/____/______
______
______
______
______
______
______
______
______
______
______
______ ______
Name: _______________________
City: _
_______________________
Date delivered:
____/____/______
______
______
______
______
______
______
______
______
______
______
______ ______
Name: _______________________
City: _
_______________________
Date delivered:
____/____/______
______
______
______
______
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______
______
______
______
______
______ ______
Name: _______________________
City: _
_______________________
Date delivered:
____/____/______
______
______
______
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______
______
______
______
______
______ ______
Name: _______________________
City: _
_______________________
Date delivered:
____/____/______
______
______
______
______
______
______
______
______
______
______
______ ______
Name: _______________________
City: _
_______________________
Date delivered:
____/____/______
______
______
______
______
______
______
______
______
______
______
______ ______
Name: _______________________
City: _
_______________________
Date delivered:
____/____/______
______
______
______
______
______
______
______
______
______
______
______ ______
Name: _______________________
City: _
_______________________
Date delivered:
____/____/______
______
______
______
______
______
______
______
______
______
______
______ ______
Name: _______________________
City: _
_______________________
Subtotal
______
______
______
______
______
______
______
______
______
______
______ ______
Grand total
______
______
______
______
______
______
______
______
______
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______ ______
(See instructions.)
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*036111110*
RL-53 front (R-04/12) IL-492-1500
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Parent category: Financial