Form Alc 109 - Alcoholic Beverage Enforcement Tax Return
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1
2TENNESSEE DEPARTMENT OF REVENUE
ALCOHOLIC BEVERAGE ENFORCEMENT TAX RETURN
Account No.
Filing Period
SSN OR FEIN
ALC
Beginning:
Due Date
109
Ending:
This return must be filed and the proper tax
paid on or before the 15th day of the month
following the period covered. The return must
be filed timely even though no tax is due.
Make your check payable to the Tennessee
Department of Revenue for the amount shown
on Line 11 and mail to:
Tennessee Department of Revenue
Andrew Jackson State Office Building
500 Deaderick Street
Nashville, TN 37242
REMINDERS
IF AN AMENDED
1. Read instructions on reverse side before preparing this return.
RETURN
2. Carry Lines 1, 2, and 3 below to four decimal places.
CHECK HERE
3. Sign and date your return in the signature box below.
WRITE NUMBERS LIKE THIS
ROUND TO NEAREST DOLLAR
CASES-TO FOUR DECIMAL PLACES
WINE
& HIGH ALCOHOL
DISTILLED SPIRITS
CONTENT BEER > 7%
1. Total cases sold at wholesale .......................................
______________________________
_______________________________
2. Less: Gross cases returned from retailers ...................
______________________________
_______________________________
3. Taxable cases sold at wholesale (subtract Line
2 from Line 1) ................................................................
______________________________
_______________________________
4. Tax liability (multiply Line 3 by $
) ......................
______________________________
_______________________________
5. Less Authorized adjustments ........................................
______________________________
_______________________________
6. Net Tax Due (Line 4 minus Line 5) ...............................
______________________________
_______________________________
7. Total Tax Due (Add Line 6, columns 1 & 2) ....................................................................................
_______________________________
8. Credits: Enter outstanding amounts from previous Department of Revenue notice(s) .................
_______________________________
9. Penalty - if filed late, see instructions on reverse side ....................................................................
_______________________________
10. Interest - if filed late, see instructions on reverse side; current interest rate per annum is
%
_______________________________
11. Total remittance amount (Add lines 7, 9, & 10; less Line 8, if applicable) ..............................
00
I declare this is a true, complete, and accurate return to the best of my knowledge.
FOR OFFICE
USE ONLY
SIGN
HERE
Date
Signature of taxpayer
SIGN
HERE
If preparer other than taxpayer
Date
INTERNET (6-11)
RV-R0005501
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