Form Schedule A - State Tax Application Schedule A - List Of Label Renewal For Distilled Spirits

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Schedule A (Rev. 1/13)
Georgia Department of Revenue
Alcohol and Tobacco Division
Telephone: (404) 417-4900
E-mail:
ATDIV@dor.ga.gov
STATE TAX APPLICATION
SCHEDULE A – LIST OF LABEL RENEWAL
FOR DISTILLED SPIRITS
Submit online at
https://gtc.dor.ga.gov
STATE TAXPAYER IDENTIFIER
ALCOHOL LICENSE NUMBER
LEGAL BUSINESS NAME
List name and required information for each brand of liquor you are renewing and plan to continue to sell in the State of Georgia. List the label
names in alphabetical order.
% OF ALCOHOL CONTENT
LABEL TYPE NAME
TYPE
LABEL NAME
AGE (YRS)
BY VOLUME
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
I DECLARE UNDER PENALTY OF PERJURY THAT THIS STATEMENT HAS BEEN EXAMINED BY ME, AND TO THE BEST OF MY KNOWLEDGE
AND BELIEF IS TRUE, CORRECT AND COMPLETE.
Signature
Title
Date
(Must be signed by licensee. Licensee must also be the owner, partner, or an authorized officer of the corporation.)

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