Form 61a508 - Annual Report Of Distilled Spirits In Bonded Warehouse - 2003 Page 2

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61A508 (11-03)
ANNUAL REPORT OF DISTILLED SPIRITS
Page 2
IN BONDED WAREHOUSE
Commonwealth of Kentucky
REVENUE CABINET
Sheet No. ______ of ______ Sheets
AS OF JANUARY 1, ________
Name and Address of Distillery
Distilled Spirits in New Cooperage
Distilled Spirits in Reused Cooperage
County ________________________________
Other Than Scotch Whiskey
School District __________________________
Scotch Whiskey
D.S.P. No. _________________
Fire District ____________________________
Natural Spirits ________ Proof
New Cooperage
Reused Cooperage
Light Whiskey
PART I
45–50
35–45
45–50
35–45
45–50
35–45
1. 0 to 1
yr. old
2. 1 yr. plus to
2 yrs. old
3. 2 yrs. plus to
3 yrs. old
4. 3 yrs. plus to
4 yrs. old
5. 4 yrs. plus to
5 yrs. old
6. 5 yrs. plus to
6 yrs. old
7. 6 yrs. plus to
7 yrs. old
8. 7 yrs. plus to
8 yrs. old
9. 8 yrs. and
over
TOTAL
PART II
45-50 Gallon
Fair Cash Value
35-45 Gallon
Fair Cash Value
Gin
Vodka
Scotch Whiskey
Other
TOTAL
PART III
Estimated Fair Cash
Signature of
Size of Cases
Number of Cases
Value Per Case
Warehouseman _______________________________________________
Subscribed and sworn to before me this _______________________ day of
__________________ , _________ .
TOTAL
The affiant, ____________________________________________________ ,
Signature of Notary Public ______________________________________
stated that all distilled spirits in Warehouse No. __________________ at the
opening of business, January 1, ______________ , are included in this report
My commission
expires ______________________________________________________
in accordance with KRS 132.130.

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