Form Ab&t 4000a-225-1 - Taxpaid Cigarette Wholesale Dealer'S Monthly Report
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1DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-225-1
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE FL 32399-1022
TAXPAID CIGARETTE WHOLESALE DEALER'S MONTHLY REPORT
Prepare in TRIPLICATE. Submit ORIGINAL and FIRST COPY to the AUDITING OFFICE of the DIVISION OF ALCOHOLIC BEVERAGES AND
TOBACCO. SECOND COPY is to be retained by the licensee. This report and payment must be filed in accordance with the provisions of
Chapter 210, Florida Statutes, on or before the tenth day of the month following the month being reported. Make remittances payable to the
"Division of Alcoholic Beverages and Tobacco".
(
)
Permit Name
Phone No.
Permit No.
Address
City
State
Zip
Month Reported
Yr
Reporting Period
through
This report is true and correct to the best of my knowledge and belief and is submitted under penalty of perjury.
Typed or Printed Name
Authorized Signature
SUMMARY OF TRANSACTIONS
Stamped 20s
Stamped
s
1.
Beginning Balance
2.
Purchased In-State
3.
Returns to Stock
4.
5.
Total to Account For (Add lines 1 thru 4)
6.
Sold in County Areas
7.
Sold to Florida Wholesalers
8.
9.
Total Accounted For (Add lines 6 thru 8)
10.
Book Balance (Line 5 minus line 9)
11.
Inventory (Actual)
12. Over / Short (Line 11 minus line 10)
DAB&T USE ONLY
REPORT RECEIPT
In'ls
FIELD REVIEW
In'ls
CENTRAL PROCESSING
In'ls
Initial Receipt Date
Postmark Date
Initial Review Date
Completed Date
Delivery Date
Amended Date
Delinquency Action
Amended Amount
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