Arizona Form 815 - Wholesaler'S Return Of Spirits And Vinous Sold, And Malt/cider Liquor Purchased
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6Wholesaler’s Return of
Arizona Form 815
Spirits and Vinous Sold, and Malt/Cider Liquor Purchased
This return and the tax shown is due not later than the 20th day of the 1st month following the month for which this
return is made and is delinquent if the tax is not paid within ten (10) days after the due date.
Amended Return
Final Return (LICENSE CANCELED)
New License Number
Liquor License Number: Taxpayer I.D. Number:
Legal Business Name
Period Beginning:
Period Ending:
Business (or dba) Name
M
M D D Y Y Y Y
M
M D D Y Y Y Y
Mailing Address
NEW
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
88
City
State ZIP Code
Business Location Address
NEW
City
State ZIP Code
Name of Contact Person
Telephone No.
81 PM
80 RCVD
NEW
NEW
E-mail Address
Fax No.
NEW
NEW
File a separate return for each license. Read
instructions
beginning on page 5 prior to completing the return.
(a)
(b)
(c)
SPIRITS
VINOUS
MALT/CIDER
No. of Gallons
No. of Gallons
No. of Gallons
1 Beginning Inventory (same as ending inventory of
prior month) ....................................................................
2 Additions – total gallons:
a Received/purchased this month – from Schedule A ..
b Returned from retailers ..............................................
3 TOTAL ADDITIONS (Add lines 2a and 2b) ....................
4 Deductions – total gallons:
a Sold to military installations – from Schedule B .........
b Exported from Arizona – from Schedule C ................
c Sold to Arizona wholesalers – from Schedule D ........
d Purchased from Arizona wholesalers –
from Schedule D ........................................................
e Destroyed ..................................................................
f Breakage ...................................................................
g Returned to suppliers.................................................
h Returned from retailers ..............................................
5 TOTAL DEDUCTIONS (Add lines 4a through 4h) ..........
6 Other Adjustments – gain or loss ...................................
7 Ending Inventory ............................................................
8 Taxable gallons sold/purchased .................................
9 Tax Rates.......................................................................
$
3.00
$
0.84
$
0.16
$
$
$
10 Tax Due (Multiply line 8 by line 9) ..................................
11 TOTAL TAX DUE: (Add line 10, columns a, b, and c) ................................................................................................
$
Declaration of preparer (other than taxpayer) is based on all
I have read this report and any attachments with it. Under penalties
information of which preparer has any knowledge.
of perjury, I declare that to the best of my knowledge and belief, they
are correct and complete.
PREPARER’S SIGNATURE
TAXPAYER’S OR AUTHORIZED AGENT’S SIGNATURE
PREPARER’S TIN
DATE
TITLE
DATE
Please mail to: Arizona Department of Revenue, Liquor Tax, PO Box 29019, Phoenix, AZ 85038-9019
ADOR 11080 (9/13)
Previous 14-2048 (2/07)
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