Form Asr - Alcohol Sales On Reservations

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ASR
Alcohol Sales on Reservations
Check if Amended
Company Name
FEIN
Address
Minnesota Tax ID Number
Location Code
City
State
ZIP
Period of Return
Beer
Wine
Distilled Spirits
Bottles
More
Less
More Than
More Than
More Than
Sparkling
Cider
Distilled Spirits Low-Alcohol
Wine & Distilled
(liters)
(liters, excluding
Name of Tribe
Than 3.2%
Than 3.2%
14% or Less
14% to 21%
21% to 24%
24%
Wine
Dairy
Miniatures
Spirits
(in barrels)
(in barrels)
(liters)
(liters)
(liters)
(liters)
(liters)
miniatures)
(liters)
(
50 ml)
(200 ml or more)
Bois Forte Band of Chippewa
Fond du Lac Band of Chippewa
Grand Portage Band of Chippewa
Leech Lake Band of Chippewa
Lower Sioux Community
Mille Lacs Band of Chippewa
Prairie Island Sioux Community
Red Lake Band of Chippewa
Shakopee Mdewakanton Sioux Community
Upper Sioux Community
White Earth Band of Chippewa
Sign here: I declare that this form is correct and complete to the best of my knowledge and belief.
Authorized Signature
Print Name
Title
Date
Daytime Phone
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. 1/18)

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