Form Lb41 - Excise Tax Return For Brewers

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LB41
Excise Tax Return for Brewers
Due by the 18th of the month following the period in which the sales were made, even if no tax is due.
Check if Amended
Company Name
FEIN
Address
Minnesota Tax ID Number
Location Code
City
State
ZIP Code
Period of Return
A
B
More Than 3.2%
3.2% or Less
(in barrels; see instructions)
(in barrels; see instructions)
1 Shipments of beer to Minnesota wholesalers (from Schedule A) . . . . . . . . . . . . . 1
2 Return from Minnesota wholesaler (from Schedule B) . . . . . . . . . . . . . . . . . . . . . 2
3 Miscellaneous credits or reductions (from Schedule C) . . . . . . . . . . . . . . . . . . . . . 3
4 Total deductions (add lines 2 and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Total taxable shipments to Minnesota wholesalers
(subtract line 4 from line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
$4.60
$2.40
6 Tax rates per barrel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Multiply line 5 by line 6 in each column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Add amounts on line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 $
9 Qualified brewer credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 $
10 TOTAL TAX DUE (subtract line 9 from line 8) (see instructions for payment options) . . . . . . . . . . . . . . . . . . . 10 $
Check method of payment:
Electronic payment
Check
(make payable to Minnesota Revenue)
I declare that this return and accompanying schedules are correct and complete to the best of my knowledge and belief.
Authorized Signature
Date
Daytime Phone
Print Name
Title
Paid Preparer’s Signature
PTIN
Date
Daytime Phone
Mail to: Minnesota Revenue, Mail Station 3331, St. Paul, MN 55146-3331
Phone: 651-556-3036 Fax: 651-556-5236 Email: alc.taxes@state.mn.us
(Rev. 9/14)

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