Fillable Form 73a630 - Abc Microbrewer'S Retail Gross Receipts Report- June 2013 printable pdf download

Form 73a630 - Abc Microbrewer'S Retail Gross Receipts Report- June 2013

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73A630 (05-13)

ABC Microbrewer's Retail Gross

Receipts Report- June 2013

COMMONWEALTH OF KENTUCKY

DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL

1003 Twilight Trail

Frankfort, Kentucky 40601-8400

502-564-4850 phone

502-564-1442 fax

File with each Distributor on or before the 10th of the month following the month for which the transaction(s) occurred.

Name and Address of Principal or Agent

Revenue Account Number

State License Number

Report for Month of

For assistance, you may contact the Excise Tax Section at (502) 564-6823 or via email at

DORWEBResponseExciseTax@ky.gov.

1. Total gallons sold during month .................................................................................................................................... _____________________

2. Total gallons sold at wholesale ...................................................................................................................................... _____________________

3. Total gallons sold at retail (line 1 minus line 2) .............................................................................................................. _____________________

4. Contract price per gallon (per written wholesale contract) .......................................................................................... $_____________________

5. Gross receipts subject to tax (line 3 times line 4) ........................................................................................................ $_____________________

6. Wholesale sales tax rate .............................................................................................................................................. _______X_____0.11_____

7. Net wholesale sales tax due to distributor (line 5 times line 6) ................................................................................... $_____________________

I, the undersigned, a principal officer of the above-named licensee, certify that I have examined this report and it is, to the best of my knowledge and

belief, a true, correct and complete report.

____________________________________

Print Name

Title

____________________________________

Signature

E-Mail

____________________________________

Date

Phone Number