Form B-4 - Monthly Indiana Beer Wholesalers Purchase Report Of Beer Received From An Indiana Brewery Page 2

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B-4 (Formerly Schedule E-2)
Beer Received From Indiana Breweries
Page__________of _____________Pages
Date
Beer Gallons
Invoice Number
Indiana Brewery
No.
Received
Per Invoice
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Total Beer Gallons
Use one invoice per line.

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