Dbpr Form Ab&t - Vendor'S Malt Manufacturing Return
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2DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-130-1
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE, FL 32399-1022
VENDOR'S MALT MANUFACTURING RETURN
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. Compute in Wine Gallons (128 fluid ounces per gallon) to cover a calendar
month. 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 561.11,
Florida Statutes.
Licensee Name
Phone No.
(
)
License No.
Address
City
FL
Zip
Month Reported
20
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
PRODUCTION SUMMARY
Batch Number
Bulk Gallons
Batch Number
Bulk Gallons
Batch Number
Bulk Gallon
INVENTORY SUMMARY
Total Produced
Bulk Gallons
COMPUTATION OF TAX
Beginning Inventory
Produced (+)
Bulk Gallons Produced
=
$
Sales (-)
@ $0.48 per Gallon
=
$
Book Balance
Certificate of Credit
=
$
Ending Inventory
Certificate of Credit
=
Net Amount To Be
Over/Short
Remitted With Report
$
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
Delinquent Action
Excise Tax Paid
Amended Amount
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