Arizona Form 835 - Domestic Farm Winery / Domestic Microbrewery / Domestic Cider Return Of Liquor Sold

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Definitions
Domestic Farm Winery / Domestic Microbrewery / Domestic Cider
Arizona Form 835
Return of Liquor Sold
This return and the tax shown is due not later than the 20th day of the 1st month following the month for which this return
is made and is delinquent if the tax is not paid within ten (10) days after the due date.
Amended Return
Final Return (LICENSE CANCELED)
New License Number
Liquor License Number: Taxpayer I.D. Number:
Legal Business Name
Period Beginning:
Period Ending:
Business (or dba) Name
M
M D D Y Y Y Y
M
M D D Y Y Y Y
Mailing Address
NEW
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
88
City
State ZIP Code
Business Location Address
NEW
City
State ZIP Code
Name of Contact Person
Telephone No.
NEW
NEW
81 PM
80 RCVD
E-mail Address
Fax No.
NEW
NEW
File a separate return for each license. Read
instructions
beginning on page 4 prior to completing the return.
(a)
(b)
(c)
VINOUS
MALT
CIDER
No. of Gallons
No. of Gallons
No. of Gallons
1. Gallons sold ......................................................................
2. Deductions – total gallons:
a. Sold to military installations – from Schedule B ...........
b. Exported from Arizona – from Schedule C ...................
c. Sold to Arizona wholesalers – from Schedule D ..........
d. Tax paid – beverage returned.......................................
3. TOTAL DEDUCTIONS (Add lines 2a through 2d) ...............
4. Other Adjustments – gain or loss ........................................
5. Taxable gallons sold to consumers/
Arizona retail stores .........................................................
$
0.84
$
0.16
$
0.16
6. Tax Rates ...........................................................................
$
$
$
7. Tax Due (Multiply line 5 by line 6) .......................................
$
8. TOTAL TAX DUE: (Add line 7, columns a, b, and c) ...................................................................................
Declaration of preparer (other than taxpayer) is based on all
I have read this report and any attachments with it. Under penalties
information of which preparer has any knowledge.
of perjury, I declare that to the best of my knowledge and belief, they
are correct and complete.
PREPARER’S SIGNATURE
TAXPAYER’S OR AUTHORIZED AGENT’S SIGNATURE
PREPARER’S TIN
DATE
TITLE
DATE
Please mail to: Arizona Department of Revenue, Liquor Tax, PO Box 29019, Phoenix, AZ 85038-9019
ADOR 11081 (9/13)
Print
Previous 14-2049 (2/07)

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