Form 73a627 - Beer Distributor'S Monthly Report
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173A627 (2-11)
BEER DISTRIBUTOR’S MONTHLY REPORT
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
Name and Address of Distributor
State License Number
INSTRUCTIONS: File report with the Department of Revenue on or before the 20th day of the month
following the month covered by the report. Include all malt beverages received during the reporting
month. List each shipment separately and group by supplier. Make separate entry for beer returned
Report for Month of
to brewer-importer. Attach continuation schedule(s) if necessary. File separate report for each distributor
license held. Report must be filed even if there are “No Transactions” during a month. Return to
Department of Revenue, Frankfort, Kentucky 40619.
____________________________ 20____
Invoice
1/2
1/4
1/6
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Others
Others
Others
Date
Name of Supplier
Address
No.
Bbl.
Bbl.
Bbl.
24-7 oz.
32-7 oz.
36-7 oz.
48-7 oz.
30-12 oz.
15-12 oz.
12-12 oz.
24-12 oz.
24–14 oz.
24-16 oz.
12-24 oz.
12-32 oz.
12–40 oz.
Cases
Cases
Cases
1. Net amount of beer received during month .......................
2. Inventory at beginning of month .........................................
3. Inventory at end of month ....................................................
4. Net sales during month (lines 1 plus 2 minus 3) ...............
I, the undersigned, a principal officer of the above-named licensee, do attest that I have examined this report and it is, to the best
Date ________________________________________________
of my knowledge and belief, a true and complete report.
(
)
Telephone Number _____________________________________
Signature_______________________________________________ Title ___________________________________________
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