C
W
, G
ITY OF
AYCROSS
EORGIA
P. O. Drawer 99 – 417 Pendleton Street – Waycross, GA 31502-0099
Tele (912) 287-2964 – Fax (912) 287-2946 –
EXCISE TAX RETURN ON THE SALE OF DISTILLED SPIRITS BY THE DRINK
Return for the Month of: __________________________________________ Date Filed: _________________________________
Business Name: ______________________________________________________________________________________________
Address: ___________________________________________________________________________________________________
City: ____________________________________________________ State: ______________________ Zip: _________________
GA Sales Tax No.: ___________________________________________ Phone: _________________________________________
O.C.G.A. § 3-4 130, et seq. authorizes each municipality in which the sale of distilled spirits by the drink is
permitted to impose, levy, and collect an excise tax upon the sale of beverages, which tax shall not exceed three
th
percent of the charges to the public for the beverages. therefore, on or before the 15
day of the month
following each monthly period a return for the preceding monthly period shall be filed with the city clerk
showing the gross sales of liquor by the drink by the licensee during the applicable period and the amount of the
tax collected or the otherwise due under this article for the related period.
$ 0.00
Gross Receipts of the Month
________________________
1.
0.00
Amount of Tax Due (.03 x Line 1)
________________________
2.
0.00
Less Service Fee (.03 x Line 2)
________________________
3.
0.00
Total Tax Due City (Line 2 minus Line 1)
________________________
4.
th
Penalty (Payment Postmarked after the 15
will) ________________________
5.
$ 0.00
Amount Remitted to the City
________________________
6.
I (WE) DO SOLEMNLY SWEAR, SUBJECT TO CRIMINAL PENALTIES FOR THE FALSE SWEARING, THAT
THE ABOVE INFORMATION IS TRUE AND CORRECT.
_____________________________________________
PRINT NAME
_____________________________________________
SIGNATURE
Please return this form together with your check for the amount shown on line 6, to the address below, prior to
th
the 15
of the month.
CITY OF WAYCROSS, EXCISE TAX RETURN, P.O. DRAWER 99, WAYCROSS, GEORGIA 31502
REV 06/2013