Form Alc 119 - Brand Registration Return For New Brands printable pdf download

Form Alc 119 - Brand Registration Return For New Brands

TENNESSEE DEPARTMENT OF REVENUE

Brand Registration Return for New Brands

Account No.

Effective Date

SSN OR FEIN

ALC

119

}

If this is an AMENDED RETURN,

please check the box at right

_________________________________________________________

Name:

Make your check payable to the Tennessee Department

of Revenue for the amount shown on Line 3 and mail to:

TENNESSEE DEPARTMENT OF REVENUE

Andrew Jackson State Office Building

_________________________________________________________

Address:

500 Deaderick Street, Nashville TN 37242

Should you need assistance, please contact the Taxpayer

and Vehicle Services Division by calling our statewide

________________________________

State:

_____

Zip:

__________

City:

number (800) 342-1003 or (615) 253-0600.

ROUND TO NEAREST DOLLAR

WRITE NUMBERS LIKE THIS

1. Number of New Brands of Distilled Spirits (see instructions)........(1a).__________ x (1b) $___________ ...

(1)

If the amount reported on Line 1 is a prorated amount due to registering initially for a portion of the year

only, indicate the number of months for which the tax is being remitted...........(1c) _____________ months.

See instructions on the reverse for guidance on how to prorate the tax due.

0 0

2. Number of New Brands of Wine (see instructions)...................(2a).__________ ......................................

(2)

3. Brand Registration Tax Due on Newly Registered Brands (From Line 1)................................................... (3)

RV-R0012401

FOR OFFICE USE ONLY

I declare this is a true, complete, and accurate return to the best of my knowledge.

SIGN

HERE

President or other Principal Officer, Partner, or Proprietor

Date

SIGN

HERE

Tax Return Preparer and Title

Date

11914000000000000000000000000000000000000000000000000000000000000000

INTERNET (08-11)

Form Alc 119 - Brand Registration Return For New Brands

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