Form Bt-5a - Schedule A1 - Alcoholic Beverages Tax - In Transit Items

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STATE OF CONNECTICUT
Schedule A1
Schedule A1
Schedule A1
Schedule A1
Schedule A1
DEPARTMENT OF REVENUE SERVICES
Excise/Public Services Taxes Subdivision
Alcoholic Beverages Tax
25 Sigourney Street
In Transit Items
Hartford CT 06105-5032
Rev. 06/01
For the month of ________________________ , _____
Name of Distributor: ____________________________________________
Address: ________________________________________
Instructions
1. Use this form to report all purchases of alcoholic beverages made during the month listed above that have not been received.
2. Attach this form to Form BT-5, Schedule A, Alcoholic Beverages Tax - Receipt of Tax Free Purchases and Tax Free Returns.
FORTIFIED
DISTILLED
STILL WINES
BEER
ALCOHOL AND
LIQUOR COOLERS
NAME AND ADDRESS
Not Over 21% Alcohol
WINES
LIQUOR
COMPONENTS
Not Over
Wine Gallons
Over 21%
of person, firm, or corporation from
DATE
INVOICE
Wine Gallons
for Manufacturing
7% Alcohol
Produced by
Produced by
Alcohol
Convert Draft
All Other
whom alcoholic beverages were
OF
NUMBER
Wineries That
Small Wineries
Proof Gallons
Wine Gallons
and SPARKLING
Size to bbls.
Containers
purchased during the month listed
Are Not Small
(Producing
PURCHASE
WINES
Wineries
55,000 Wine Gal.
Barrels
Wine Gallons
above but that have not been received
Wine Gallons
or less per year)

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