Form Com/att-34-10 - Finished Products Disposition Report Of Samples Used

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Comptroller of Maryland
MATT Regulatory Division
Alcohol & Tobacco Tax
Louis L. Goldstein Treasury Building
P. O. Box 2999
Annapolis, Maryland 21404-2999
(410) 260-7314
Finished Products Disposition Report of Samples Used
Sheet no.
Report of
Schedule
G-6
Address
Month of
, 2
DISTILLED SPIRITS
Size
1.75L
1L
750ml
500ml
375ml
200ml
100ml
50ml
Gallons
Cases
Bottles
Total Distilled Spirits
WINE
Size
4L
3L
1.5L
1L
750ml
375ml
187ml
100ml
Gallons
Cases
Bottles
Total Wine
Purpose
Reason
Total Wine
Total Distilled Spirits
A.
Samples of alcoholic beverages to licensed retailers
1. Removed by wholesaler representatives
2. Removed by supplier representatives
B
Donated product
1
Charitable organizations
2
Other non-profit organizations
3. Alcoholic Beverages Trade associations
C
Sample product to authorized alcoholic beverage experts
D
Samples to officers, officials, employees of wholesalers
1. Personal use
2. Business use
Total
____ ______
Wholesale licensees must maintain individual request and disposition documentation for all samples used. This documentation is subject to
audit. Documentation must include: numbered ticket, date of disposition, donee’s name and address, brand and quantity (case/bottles) with
appropriate gallonage for wine and distilled spirits, reason (appropriate letter from above list), signatures of person authorizing and person
receiving samples, and any other pertinent data.
Note: Submit original and a copy of this form to the MATT Regulatory Division. Keep a copy of this form for your records.
COM/ATT-34-10
Rev. 07/08

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