Form Bt-4-Bw - Monthly Report Of Custom Bonded Warehouses - Connecticut Department Of Revenue
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1Form BT-4-BW
STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
PO Box 5034
Monthly Report Of
Hartford Ct 06102-5034
Custom Bonded Warehouses
Rev. 04/01
This monthly report must be filed with the Commissioner of Revenue Services not later than the last day of the month following
the calendar month being reported. Attach all schedules as noted on the reporting lines below.
Name of Licensed Distributor
Return for Month of:
Address Where Business Is Licensed
License No.
City or Town, State
ZIP+4
Name of Permittee
Location of Warehouses
Liquor Control Commission Permit Number
FORTIFIED WINES
DISTILLED LIQUORS
STILL WINES
ALCOHOL
over 21% alcohol
and
not over 21% alcohol
and
components for
Sparkling Wines
manufacturing
Wine Gallons
Wine Gallons
Wine Gallons
Proof Gallons
1.
Inventory in Bond at the Beginning of the Month
2.
Total of Merchandise Placed in Custom Bonded
Warehouses (Schedule BW-1) .........................
3.
Total (Add Line 1 and Line 2) ...............................
4.
Inventory in Bond at the End of the Month ...........
5.
Accountable Balance (Line 3 minus Line 4) ........
6.
Total Merchandise Withdrawn From Custom
Bonded Warehouses (Schedule BW-2) (Report
on Form BT-5, Schedule A) .............................
7.
Total Merchandise Transferred in Bond Outside
Connecticut (Schedule BW-3) ...........................
8.
Total Merchandise Transferred in Bond Inside
Connecticut (Schedule BW-4)
9.
Total Adjustment (Schedule BW-5) ....................
10. Total (Add Line 6 and Line 9) ...............................
11. Difference, if any (Line 5 minus Line 10) ............
Declaration: I declare under the penalty of false statement that I have examined this report, Form BT-4-BW, and to the best of my knowledge and
belief it is true, complete, and correct. (The penalty for false statement is imprisonment not to exceed one year or a fine not to exceed two thousand
dollars, or both.) Declaration of preparer (other than the taxpayer) is based on all information of which preparer has any knowledge.
Signature of Principal Officer
Title
Date
Telephone Number
Sign Here
(
)
Print Name of Principal Officer
Keep a copy
of this return
Paid Preparer’s Signature
Date
for your
records
<
Firm Name and Address
Federal Employer Identification Number
For Department use only:
Reviewed by: ______ Audited by: _____________
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