Form 73a529 - Consignor'S Report Of Alcoholic Beverages Shipped

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Check One
73A529 (1-07)
CONSIGNOR’S REPORT OF ALCOHOLIC
Commonwealth of Kentucky
Intrastate
BEVERAGES SHIPPED
DEPARTMENT OF REVENUE
Out-of-State
Consignor (Name and address of party shipping merchandise)
Consignee (Name and address of party to whom shipped)
Date Shipped:
Name of Carrier:
Number of barrels and/or cases contained in shipment
Kind of
Half-Pint
Other
Other
Beverage
2.4 Gal.
18 Liter
16 Liter
12 Liter
10.5 Liter
9.6 Liter
9 Liter
187 Milliliter
(specify)
(specify)
Spirits
XXXXXX
XXXXXX
XXXXXX
XXXXXX
Wine
SUBMIT IN DUPLICATE
If consignor is not vendor or consignee is not vendee show name and address of both.
Signature of Official of Consignor Making Report
Check One
73A529 (1-07)
CONSIGNOR’S REPORT OF ALCOHOLIC
Commonwealth of Kentucky
Intrastate
BEVERAGES SHIPPED
DEPARTMENT OF REVENUE
Out-of-State
Consignor (Name and address of party shipping merchandise)
Consignee (Name and address of party to whom shipped)
Date Shipped:
Name of Carrier:
Number of barrels and/or cases contained in shipment
Kind of
Half-Pint
Other
Other
Beverage
2.4 Gal.
18 Liter
16 Liter
12 Liter
10.5 Liter
9.6 Liter
9 Liter
187 Milliliter
(specify)
(specify)
Spirits
XXXXXX
XXXXXX
XXXXXX
XXXXXX
Wine
SUBMIT IN DUPLICATE
If consignor is not vendor or consignee is not vendee show name and address of both.
Signature of Official of Consignor Making Report
Check One
73A529 (1-07)
CONSIGNOR’S REPORT OF ALCOHOLIC
Commonwealth of Kentucky
Intrastate
BEVERAGES SHIPPED
DEPARTMENT OF REVENUE
Out-of-State
Consignor (Name and address of party shipping merchandise)
Consignee (Name and address of party to whom shipped)
Date Shipped:
Name of Carrier:
Number of barrels and/or cases contained in shipment
Kind of
Half-Pint
Other
Other
Beverage
2.4 Gal.
18 Liter
16 Liter
12 Liter
10.5 Liter
9.6 Liter
9 Liter
(specify)
(specify)
187 Milliliter
Spirits
XXXXXX
XXXXXX
XXXXXX
XXXXXX
Wine
SUBMIT IN DUPLICATE
If consignor is not vendor or consignee is not vendee show name and address of both.
Signature of Official of Consignor Making Report

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