Comptroller of Maryland
MATT Regulatory Division
Alcohol and Tobacco Tax
P.O. BOX 2999
Annapolis, Maryland 21404-2999
(410) 260-7314
888-784-0145
REPORT OF PRODUCTION OF ALCOHOL FOR FUEL USE (NON-COMMERCIAL OR EXPERIMENTAL)
For period ending October 31, 20 ___
Name of Permit Holder: ______________________________________________________________________
Address: __________________________________________________________________________________
City: ____________________ County: ________________ State: _______________ Zip Code: ____________
Type of Apparatus: _________________________________________________________________________
Type of Mash: _________________________ Type of Denaturant Used: ______________________________
Fermenting Cycle of Mash: ___________________________________________________________________
Total Capacity of Fermenters: ___________________________________________________________Gallons.
Capacity of Apparatus: ________________________________________________________________ Gallons.
Operating Period of Apparatus: _________________________________________________________________
Daily Production Capacity: _____________________________________________________________ Gallons.
Undenatured Alcohol
Denatured Alcohol
A. Total Gallons of Alcohol on Hand at
Beginning of Year
B. Total Gallons of Alcohol Produced
During Year
C. Total Gallons of Alcohol Denatured
During Year
D. Total Gallons Converted to Fuel Use
During Year
E. Total Gallons of Alcohol on Hand at
End of Year
Note:
This form covers activity of a Fuel-Alcohol permittee from November 1 through October 31 annually and must be filed by
November 15 subsequent to the report period. Failure to file this report in a timely fashion will subject the permit to
suspension or revocation proceedings.
Signature
Title
Date
COM/ATT-22
Rev. 10/07
1
