Form Com/att-028 - Report Of Activities By Holder Of Import-Export Or Non-Resident Storage Permit

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Comptroller of Maryland
MATT Regulatory Division
Alcohol and Tobacco Tax
P.O. Box 2999
Annapolis, Maryland 21404-2999
Telephone 410-260-7314/888-784-0145
Fax# 410-974-3201
REPORT OF ACTIVITIES
BY HOLDER OF IMPORT-EXPORT OR NON-RESIDENT STORAGE PERMIT
Report of
Month of
(Permit Name)
Date Prepared
Address
Permit Number
INSTRUCTIONS
Complete with typewriter or neatly in ink.
Form must be signed by the owner, partner, officer or authorized agent.
Completed forms must be received in the Annapolis Office of the Alcohol and Tobacco Tax office no later than the
th
15
day of the month following the report month and must be filed even if you had no activity in the report month.
Complete Part A (summary), Part B (shipments to licensed public storage warehouse in Maryland) and Part C (shipments
from licensed public storage warehouse in Maryland). Parts B & C appear on the reverse side of the form. The ending
totals on Line 5 of Part A should be the beginning totals on Line 1 of the next month’s report. In Parts A,
B and C, list beer, wine and spirits in packages (cases, kegs, etc.). If more space is needed for Parts B and C, use
additional forms.
You may only store alcoholic beverages in a public storage warehouse licensed by the Alcohol and Tobacco Tax office,
with the exception of alcoholic beverages stored in United States Customs Bond. If stored in Bond, so designate in Part
B behind the public storage warehouse name.
Alcoholic beverages stored under an Import-Export permit must ultimately be shipped outside of Maryland and may
not be consigned, delivered or sold to any person in Maryland.
Alcoholic beverages stored under a Non-Resident Storage permit may be shipped outside of Maryland or to qualified
licensees in Maryland, provided in the latter case the invoice is issued by the Non-Resident Dealer concurrent with the
shipment.
PART A
SUMMARY OF ACTIVITIES
BEER
WINE
SPIRITS
1.
Total number of packages stored (on hand first of month)
2.
Total number of packages shipped to warehouse(s) during month
3
Combined total
4.
Total number of packages shipped or removed from warehouse(s) during month
5.
Total number of packages stored in warehouse (on hand end of month)
STATEMENT
I certify that this report, together with attached schedules, has been examined by me and is, to the best of my knowledge
and belief, a true and complete report for the month stated, in accordance with the provisions of Article 2B of the Annotated
Code of Maryland, as amended, title “Alcoholic Beverages”, and the regulations issued under authority thereof.
(Signature)
(Title-Owner, Partner, Officer or Agent)
(Print Name)
(Contact Telephone Number)
COM/ATT-028
Rev. 07/07

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