Form Alc 83 A-1c - Ohio Beer And Malt Beverage Tax Return For Qualifi Ed A-1c Permit Holders Under 4303.332

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ALC 83 A-1C
Reset Form
Rev. 9/13
P.O. Box 530
Columbus, OH 43216-0530
Ohio Beer and Malt Beverage Tax Return
for Qualifi ed A-1C Permit Holders Under 4303.332
Reporting period
Account number
Return is due on or before the 10th day of
the month following the reporting period.
Name
For Department of Taxation Use Only
Address
City
State
ZIP
Telephone number
Schedule A – Beer and Malt Beverages in Barrels
Barrel Gallons
1. Sold in Ohio and/or consumed on premises in Ohio
Schedule B – Beer and Malt Beverages in Containers Other Than Barrels
24/12 OZ.
12/32 OZ.
24/7 OZ.
24/16 OZ.
Other OZ.
Other OZ.
1. Confi gurations sold in Ohio and/or consumed on premises in Ohio
2. Gallons (convert line 1 into gallons)
Total production of beer, wherever produced, for year 2013 (in gallons)
I declare under penalties of perjury that this return, including any accompanying schedules and state-
Our records indicate that you are exempt from the Ohio beer and malt beverage excise tax. This
ments, has been examined by me and, to the best of my knowledge and belief, is a true, correct and
return is required for informational purposes. Mail to Ohio Department of Taxation, P.O. Box 530,
complete return and report.
Columbus, OH 43216-0530.
If you have any questions, please (855) 466-3921.
Authorized signature
Date

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