Schedule B (Form Rev-1054) - Malt Beverage Sales To Distributors And/or Customers Outside Pennsylvania

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SCHEDULE B
REV-1054 AS+ (04-11)
BUREAU OF BUSINESS TRUST FUND TAXES
MALT BEVERAGE SALES TO DISTRIBUTORS AND/OR
MISCELLANEOUS TAX DIVISION
CUSTOMERS OUTSIDE PENNSYLVANIA
PO BOX 280909
HARRISBURG PA 17128-0909
Attach to REV-1052
Print or Type
BUSINESS NAME
DATE
ACCOUNT NUMBER
EIN
LID NUMBER
REPORTING MONTH/YEAR
SOLD INTO THE STATE OF:
(A separate schedule must be used for each state)
UNITS
OTHER
BARRELS
OTHER
INDICATE SIZE
INDICATE SIZE
NAME AND ADDRESS OF DISTRIBUTOR AND/OR CUSTOMER
1/2 PT.
1 PT.
1 QT.
1/8
1/6
1/4
1/2
CAN & BOTTLE
CAN & BOTTLE
CAN & BOTTLE
7 OZ. TO 8 OZ.
8.1 OZ. TO 16 OZ.
16.1 OZ. TO 32 OZ.
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
NAME
STREET
CITY
STATE
ZIP CODE
TOTALS

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