Form Rev-1052 - Pennsylvania Manufacturer & Bonded Importer Monthly Report Of Taxable Malt Beverage Sold To Distributors And/or Customers For Resale In Pennsylvania Page 2

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REV-1052 AS+ (04-11)
BUREAU OF BUSINESS TRUST FUND TAXES
MALT BEVERAGE MANUFACTURED, PURCHASED,
MISCELLANEOUS TAX DIVISION
SOLD, WITHDRAWN INVENTORIES
PO BOX 280909
HARRISBURG PA 17128-0909
Print or Type
BUSINESS NAME
DATE
ACCOUNT NUMBER
EIN NUMBER
LID NUMBER
REPORTING MONTH/YEAR
COLUMN 1
COLUMN 2
COLUMN 3
COLUMN 4
COLUMN 5
COLUMN 6
COLUMN 7
COLUMN 8
COLUMN 9
COLUMN 10
Reporting
Manufactured
Received
Total of
Reporting
Balance to
Sold into PA
Sold outside PA
Other
Total Accounted
Month
During
During
Columns
Month
Account For
Schedule A
Schedule B
Withdrawals
For (Add Total of
ITEM
DESCRIPTION
Beginning
Reporting
Reporting
1, 2
Ending
(Total of
(Attach
Columns 7, 8 and
Inventory
Month
Month
and 3
Inventory
Column 4 minus
Explanation)
9. Total of Column
Total of
10 Must Equal
Column 5)
Total of Column 6
1.
½ Pint (7 oz – 8 oz)
2.
1 Pint (8.1 oz – 16 oz)
3.
1 Quart (16.1 oz – 32 oz)
4.
Can/Bottle (32.1 oz – 48 oz)
5.
Can/Bottle (48.1 oz – 64 oz)
6.
2 Liter (64.1 oz – 80 oz)
7.
3 Liter (80.1 oz – 112 oz)
8.
Gallon (112.1 oz – 128 oz)
9.
5 Liter (160.1 oz – 176 oz)
10.
1/8 Barrel
11.
1/6 Barrel
12.
1/4 Barrel
13.
30 Liter
14.
12 Gallon
15.
50 Liter
16.
1/2 Barrel
17.
1 Barrel
18.
Other
19.
Other
20.
TOTAL

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