Form Lb40 - Malt Beverages Excise Tax Return Page 2

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LB40

Company Name

FEIN

Period of Return

Minnesota Tax ID Number

Location Code

Untaxed Shipments Received

Schedule A

List the shipments of beer received during the period .

Invoice

More Than 3.2%

3.2% or Less

Received From

Date

Number

(in barrels)

Total (enter on Form LB40, line 1)

Miscellaneous Credits or Reductions

Schedule B

List any credits or reductions, such as sales for shipments out of Minnesota, sales to common carriers engaged in interstate transportation of passen-

gers and sales to qualified approved military clubs.

More Than 3 .2%

3 .2% or Less

Date

Wholesaler

Reason

(in barrels)

Total (enter on Form LB40, line 2)

Authorized Breakage/Supervised Destruction

Schedule C

Date

Inspector who