Form Dr 0445 - Wholesaler'S Report Of Liquor And Beer Purchases Attach To Form Dr 0442

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*130445==19999*
DR 0445 (09/26/13)
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0009
(303) 205-8211 Ext. 6848
Wholesaler's Report of Liquor
and Beer Purchases
Page ____ of ____
Attach to Form DR 0442
Company Name
Account Number
Period
(MM/YY-MM/YY)
Commodity reported on this schedule, (Check one only)
Vinous Liquor (liters)
Spirituous Liquor (liters)
Hard Cider (gallons)
Malt Liquors (gallons)
3.2 Beer (gallons)
Account
Invoice
Gallons/Liters Purchased
Date
Supplier's Name
Number
Number
(MM/DD/YY)
Tax Included
Tax Not Included
Totals, this page
Grand Totals, last page only
Enter these amounts on line 3 or line 4 of form DR 0442.
Photocopy and submit additional pages as needed

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