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

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Comptroller of Maryland
MATT Regulatory Division
Alcohol and Tobacco Tax
P.O. Box 2999
Annapolis, Maryland 21404-2999
410-260-7314/888-784-0145
Fax # 410-974-3201
FAMILY BEER AND WINE FACILITY PERMIT REPORT
See reverse side for complete instructions
For the report year
Prepare this return in duplicate.
st
th
October 1
- September 30
Use typewriter or ink.
PERMIT NUMBER: FP-
20
Retain duplicate.
BEER
GALLONS
1. Produced during month
2. Samples produced
3. Produced for testing equipment, recipes, etc.
4. Total beer produced
WINE
5. Produced during month
6. Samples produced during month
7. Produced for testing equipment, recipes, etc.
8. Total wine produced
AFFIDAVIT
I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing document
are true and correct to the best of my knowledge, information and belief.
Signature
Title
Date
Type or Print Name
COM/ATT-532
Revised 9/08

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