Form Ab-Do - Alcoholic Beverage Disposal Order

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Rev. 3/13
Form AB-DO
Massachusetts
Alcoholic Beverage
Department of
Disposal Order
Revenue
The licensee hereby voluntarily surrenders for disposal, under the supervision of the undersigned Department of Revenue representative, the
following adulterated alcoholic beverage(s) for failure to meet the standards of purity and quality which it claims to possess.
Alcoholic beverages so disposed should be converted to appropriate taxable unit measurements and entered in designated tax rate sched-
ules, as well as on Form AB-1, Schedule F. Be sure to attach Form AB-1, Schedule F.
Name of licensee
License number
Date
Street address
City/Town
State
Zip
Disposed alcoholic beverages.
Include totals, as defined and calculated in Form AB-1, in designated schedules of Form AB-1.
1 Malt beverages (in gallon barrels; include in Schedule A, line 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Still wine including vermouth (in wine gallons; include in Schedule B1, line 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Champagne and other sparkling wines (in wine gallons; include in Schedule B2, line 5). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Alcoholic beverage of 15% or less alcohol (in wine gallons; include in Schedule C, line 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Alcoholic beverage of greater than 15% but less than 50% alcohol (in wine gallons; include in Schedule D, line 5) . . . . . . . 5
6 Alcoholic beverage of greater than 50% alcohol (in proof gallons; include in Schedule E, line 6) . . . . . . . . . . . . . . . . . . . . . . 6
7 Alcohol sold in containers of one gallon or less (in wine gallons; include in Schedule G, line 5) . . . . . . . . . . . . . . . . . . . . . . . 7
8 Cider of more than 3% but not more than 6% alcohol (in wine gallons; include in Schedule I, line 5) . . . . . . . . . . . . . . . . . . . 8
Product information
Name of product
Case or bottle size
Quantity
Signatures
Licensee claimant or owner
Department of Revenue representative
Witness
Date
printed on recycled paper

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