Form 73a530 - Consignor'S Report Of Alcoholic Beverages Shipped

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Submit in Duplicate
73A530 (2-11)
CONSIGNOR’S REPORT
Commonwealth of Kentucky
Return to the Department of Revenue, Frankfort,
DEPARTMENT OF REVENUE
OF ALCOHOLIC BEVERAGES SHIPPED
Kentucky 40619. For additional information, contact
the Department of Revenue at (502) 564-8998.
Consignor and License No.
Consignee State
Type Beverage
Report Date
Month
Year
Page _________ of _______
Number of Cases
Totals
Tank
Halt-Pint
4
3.2
3
2.4
12
10.5
9.6
9
Customer
Date
or Bulk
187 Milliliters
Other
Wine Gallons
Liters
Gallons
Gallons
Gallons
Gallons
Liters
Liters
Liters
Liters
Load
(Wine Only)

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