Form R-27 - Plenary Retail Transit Licensee'S Beverage Tax Report

R-27

STATE OF NEW JERSEY

DO NOT WRITE IN THIS SPACE

(7-09, Rev. 6)

DEPARTMENT OF THE TREASURY

CONTROL SHEET

DIVISION OF TAXATION

BEVERAGE TAX

FOR PERIODS BEGINNING ON AND AFTER SEPTEMBER 1, 2009

PLENARY RETAIL TRANSIT LICENSEE’S BEVERAGE TAX REPORT - I.C.C. CARRIERS

Submit original of this report and necessary schedules to the Division of Taxation, Beverage Tax, PO Box

241, Trenton, New Jersey 08695-0241.

Keep a copy of this report and all schedules for your files.

Pursuant to the provisions of Title 54 of the Revised Statutes, as amended and supplemented,

__________________________________________, _________________________________________

(PRINT THE LICENSEE NAME HERE)

(FEDERAL IDENTIFICATION NUMBER)

__________________________________________, _________________________________________

(PRINT TRADE NAME HERE, IF ANY)

(STREET ADDRESS)

__________________________________________, _________________________________________

(CITY, STATE, ZIP)

(COUNTY)

____________________________________________________________________________________

(PRINT MAILING ADDRESS IF DIFFERENT FROM ABOVE, SEE INSTRUCTION)

the holder of_________________________________ License No.(s)_____________________________

(TYPE OF LICENSE(S) SEE INSTRUCTION)

under Title 33 of the Revised Statutes, as amended, reports business transacted during the Bimonthly

Period of __________________________ and _______________________, year__________, as follows:

Sparkling

Apple Cider*

Beer and Malt

Liquors

For full

Still Wines

Vermouth

Wines*

(3.2% to 7% Alcohol)

Beverages

(Alcohol)

particulars

see instructions

Total Wine Gals.

Total Gals.

1. Actual physical inventory in

commissaries or warehouses in New

Jersey first day of period.

2. Purchases, withdrawals and transfers

from stock maintained outside this state

(Sch. “H-1”)

3. Returns accepted from dining cars,

airlines, and other carriers (Sch. “H-4”)

4. TOTAL (Items 1 plus 2 and 3)

5. Returns made to persons from whom

originally purchased and transfers to

other commissaries or warehouses at a

point outside this state (Sch. “A-E)

6. Total issued by commissaries in New

Jersey to dining cars, airlines, and other

carriers

7. Adjustments to balance physical

inventory in New Jersey commissaries or

public warehouses (include in Sch. “D”)

8. TOTAL (Items 5 plus 6 and 7)

9. Actual physical inventory in commis-

saries or public warehouses in NJ last

day of period (Item 4 minus item 8)

10. Distribution of inventory shown in Item 9

above:

In commissaries in New Jersey . . . . .

In warehouses in New Jersey . . . . . . .

COMPUTATION OF TAXES DUE AND PAYABLE WITH THIS REPORT

11. Tax Due Sales, etc. (As per Sch. “D”)

$0.12

$5.50

$0.875

$0.15

12. Tax Rates

13. Tax Due and Payable Herewith

REPORT CONTENTS (See Instructions)

That said licensee transmits herewith the sum of $________________________________ in payment of tax due on sales reported herein.

Sch. “H-1” ____________________ Sheets

Sch. “H-4” ________________________ Sheets

Sch. “D” _______________________ Sheets

Sch. “H-2” ____________________ Sheets

Sch “A-E” _________________________Sheets

Other _________________________ Sheets

*Apple cider containing more than 7% alcohol to be included under “Sparkling Wines”. Apple cider containing 3.2% to 7% alcohol to be included under “Apple Cider”.

I certify under the penalties provided by law, including license suspension or revocation, that this report (including any accompanying schedules and

statement(s)) has been examined by me and is true, correct and complete. I also certify that I am the person authorized to certify this report.

_________________________________________________________________

(_______) __________________________

__________________

SIGNATURE OF LICENSEE OR AUTHORIZED AGENT

PHONE

DATE

________________________________________________ ________________________________ (_______) ______________ __________________

SIGNATURE OF INDIVIDUAL OR FIRM PREPARING RETURN

FEDERAL IDENTIFICATION NUMBER

PHONE

DATE

Title 54 of the Revised Statutes, as amended and supplemented, provides for a penalty based on the tax of 5% per month up to a maximum of five months for failure to submit a complete

return, including schedules, by the required filing date. A separate penalty of 5% may be imposed for late payments. Interest is computed at 3% above the prime rate for every month

or fraction of a month the tax is unpaid. At the end of each calendar year, any tax, penalties and interest remaining due will become part of the balance on which interest is charged. In

addition, a $100 penalty may be added for each month that the report is late.

This report shall cover two calendar months’ business from the first to the last day of the two month period, inclusive, and shall be signed by the licensee, or the proper officer if the

licensee is a corporation, or by the duly authorized agent of the licensee. The report with schedules and check or money order (no stamps) for the amount of taxes due shall be filed with

the Division of Taxation - Beverage Tax, PO Box 241, Trenton, NJ 08646-0241, within FIFTEEN DAYS after the expiration of the period reported upon. Beverage Tax Reports shall be

filed covering each bimonthly period or part of a bimonthly period that a license is in force even though during the period no business is transacted under the license.

(OVER)

Form R-27 - Plenary Retail Transit Licensee'S Beverage Tax Report - I.c.c. Carriers

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