Dbpr Form Ab&t - Alcoholic Beverage Distributor'S Monthly Report (Page 2 of 6) in pdf

Dbpr Form Ab&t - Alcoholic Beverage Distributor'S Monthly Report Page 2

DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION

DBPR Form AB&T

DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO

4000A-100-1W

1940 NORTH MONROE STREET, TALLAHASSEE, FL 32399-1022

Revised 11/98

ALCOHOLIC BEVERAGE DISTRIBUTOR'S MONTHLY REPORT

WINE

IMPORT

DOMESTIC

Prepare in TRIPLICATE. Submit ORIGINAL and FIRST COPY to the AUDITING DISTRICT 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

561, 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." Distributors paying $50,000 or more in excise taxes per year must remit tax payments through electronic funds

transfer, as prescribed by Chapter 561.111, Florida Statutes.

License Name

Phone #

License #

Address

City

, Florida, 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

COMPUTATION OF TAX

Gallons,

UNDER 17.259%

@ $ 2.25 per gallon

Gallons, 17.259% OR MORE

@ $ 3.00 per gallon

Gallons, NATURAL SPARKLING

@ $ 3.50 per gallon

Gallons, APPLE CIDER

@ $ 0.89 per gallon

Gallons of WINE COOLERS

(Included within Line 1 Tax Calculations.)

5. GROSS TAX UPON WINE

(Lines 1, 2, 3, & 4)

6. BREAKAGE/SPOILAGE DEDUCTION

(Line 5 x .0049)

7. SUBTOTAL

(Line 5 minus line 6)

8. LESS: DISCOUNT OF 1.9%

(Does not apply if Report or Payment is filed late.)

9. CERTIFICATE OF CREDIT

(If any approved by DAB&T.)

10. NET AMOUNT EXCISE TAX

(Line 7 minus lines 8 & 9.)

Import 40033 / Domestic 40030

DAB&T USE ONLY

REPORT RECEIPT

In'ls

PAYMENT VERIFICATION

In'ls

FIELD REVIEW

In'ls

CENTRAL PROCESSING

In'ls

Postmark Date

Receipt Number

Initial Review Date

Initial Receipt Date

Delivery Date

Payment Date

Amended Date

Completed Date

Delinquency Action

Excise Tax Paid

Amended Amount

Dbpr Form Ab&t - Alcoholic Beverage Distributor'S Monthly Report Page 2

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