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R-1

STATE OF NEW JERSEY

DO NOT WRITE IN THIS

(Rev. 7-09)

DEPARTMENT OF THE TREASURY

SPACE

CONTROL SHEET

DIVISION OF TAXATION

BEVERAGE TAX

MANUFACTURER’S TAX SALES REPORT

FOR PERIODS BEGINNING ON AND AFTER SEPTEMBER 1, 2009

Submit Control Sheet, all necessary schedules and an extra copy of Schedule “E” to the Division of Taxation,

Revenue Processing Center, Beverage Tax, PO Box 241, Trenton, New Jersey 08646-0241.

Pursuant to the provisions of Title 54 of the Revised Statutes, as amended and supplemented.

__________________________________________, _________________________________________

(PRINT THE LICENSEE NAME HERE)

(FEDERAL IDENTIFICATION NUMBER)

__________________________________________, _________________________________________

(PRINT TRADE NAME HERE, IF ANY)

(STREET ADDRESS)

__________________________________________, _________________________________________

(CITY, STATE, ZIP)

(COUNTY)

____________________________________________________________________________________

(PRINT MAILING ADDRESS IF DIFFERENT FROM ABOVE, SEE INSTRUCTION)

the holder of_________________________________ License No.(s)_____________________________

(TYPE OF LICENSE(S) SEE INSTRUCTION)

under Title 33 of the Revised Statutes, as amended, reports business transacted during the Bimonthly

Period of __________________________ and _______________________, year__________, as follows:

Liquors

Sparkling

Apple Cider*

Beer and Malt

For full

(Alcohol)

Still Wines

Vermouth

Wines*

(3.2% to 7% Alcohol)

Beverages

particulars

see instructions

Total Wine Gals.

Total Gals.

1. Taxable sales, etc.

“D”

2. Exemption Claimed

per “E”

3. Sub-total

(Item 1 plus 2)

4. Sales and returns

per “A”

5. Total

(Item 3 plus 4)

COMPUTATION OF TAXES DUE AND PAYABLE WITH THIS REPORT

6. Tax due sales

(Repeat Item 3)

7. Exemption taken

per “F”

8. Balance

(Item 6 minus 7)

9. Tax Credit per “H-3”

10. Net taxable sales

(Item 8 minus 9)

11. Tax rates

$0.12

$5.50

$0.875

$0.15

12. Tax due

* Apple cider containing more than 7% alcohol to be included under Sparkling Wines. Apple Cider containing 3.2% to 7% alcohol to be included

under Apple Cider.

Title 54 of the Revised Statutes, as amended and supplemented, provides for a

penalty based on the tax of 5% per month up to a maximum of five months for

Tax Due (Total of line 12) . . . . . . . . . . . . . . . . . $ _____________________

failure to submit a complete return, including schedules, by the required filing

date. A separate penalty of 5% is required for late payments.

Interest is

Beverage Tax Credit

computed at 3% over the prime rate on the unpaid balance. At the end of each

Memo Number

_________________ . . . . . . $ _____________________

calendar year, any tax, penalties and interest remaining due will become part of

the balance on which interest is charged. In addition, a $100 penalty may be

added for each month that the report is late.

Transmitted herewith in payment of taxes due . $ _____________________

DO NOT WRITE IN THIS SPACE

This report shall cover two calendar months’ business from the first to the last of the two month period

inclusive, and shall be signed by the licensee, or the proper officer if the licensee is a corporation or by the

duly authorized agent of the licensee. The report with schedules and check or money order (no stamps) for

the amount of taxes due shall be filed with the Division of Taxation, Revenue Processing Center, Beverage

Tax, PO Box 241, Trenton, NJ 08646-0241, within FIFTEEN DAYS after the expiration of the period reported

upon. Beverage Tax Reports shall be filed covering each bimonthly period or part of a period that a license

is in force even though during the period no business is transacted under the license.

(OVER)

Form R-1 - Manufacturer'S Tax Sales Report For Periods Beginning On And After September 1, 2009

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