Form B-1 - Monthly Schedule Of Beer Received From A Source Other Than An Indiana Brewery Or Beer Wholesaler

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Indiana Department of Revenue
Monthly Schedule of Beer Received from a
Source other Than an Indiana
Form B-1
(Formerly Schedule E-1)
Brewery or Beer Wholesaler
State Form 46996
Revised 6/97
Reporting Month ________________ Year________________
Name (As Appears on Permit)
Federal I.D. Number
Mailing Address
City
State
Zip Code
State Beer Permit Number
This Schedule must be attached to Revenue Form 810.
B-1 (Formerly Schedule E-1)
List each invoice of beer shipment from a source other than an Indiana brewery or a licensed Indiana beer wholesaler during the month
.
for which this report is filed, showing Brewery/Importer, Invoice Number, Date Received and Total Beer Gallons
Page __________of __________Pages
Date
Beer Gallons
No.
Brewery/Importer
Invoice Number
Received
Per Invoice
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Total Beer Gallons ................................................................................................................
19
Use one invoice per line
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