Form Com/att-532-1 - Family Beer And Wine Facility Detail Report

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Comptroller of Maryland
Indicate:
FAMILY BEER AND WINE FACILITY DETAIL REPORT
MATT Regulatory Division
Alcohol and Tobacco Tax
(See reverse side for instructions)
Beer
Wine
Company Name
Individuals
For the report year ending September 30, 20
Samples
Permit Number: FP-
Testing
(1)
(2)
(3)
(4)
(5)
LINE
INDIVIDUAL’S
INDIVIDUAL’S
INDIVIDUAL’S
DATE
QUANTITY IN
NAME
ADDRESS
BIRTHDATE
PRODUCED
GALLONS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Sub-Total (If more than one page.)
20
Total
COM/ATT-532-1
Revised 09/08

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