Form Et-200 - Cuyahoga County Beer & Malt Beverage Tax Return

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Excise Tax Form
ET-200 (Rev. 3/01)
P.O. Box 530= Columbus, OH 43216-0530
Cuyahoga County Beer & Malt Beverage Tax Return
Return is due on or before the last day of the
Reporting Period
month following the reporting period.
For Treasurer of State
For the month of: _______________________________________________ , 20 _____
Use Only
Account Number __________________________________________________
Name __________________________________________________________
Address ________________________________________________________
City ________________________________ State __________ Zip _________
1. Gallons of Beer Sold to Cuyahoga County Retailers ............................................................... $ ____________________
2. Gallons of Beer Sold at Retail in Cuyahoga County ................................................................ $ ___________________
3. Total Taxable Gallons (line 1 + line 2) ...................................................................................... $ ___________________
4. Gross Tax (line 3 X $ .16) ..................................................................................................... $ ___________________
5. Discount (.025 X line 4) ........................................................................................................ $ ___________________
6. Net Tax (line 4 - line 5) ............................................................................................................ $ ___________________
7. Late Charge ($50 or 10% of line 4, whichever is greater) ........................................................ $ ___________________
8. Total Amount Due (line 6 + lines 7) .......................................................................................... $ ___________________
Make remittance payable to Treasurer of State of Ohio and mail to Treasurer of State, P.O. Box 16763, Columbus, OH 43216-6763.
This return must be received by the last day of the month following the reporting period.
I declare under penalties of perjury that this return, including any accompanying schedules and statements, has
been examined by me and, to the best of my knowledge and belief, is a true, correct and complete return and
report.
Signature ____________________________________________ Title ________________________________________
Date _______________________________________________

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