Use this form to report total barrels produced during the year. Due by January 18 following the year in which the barrels were produced.
Annual Beer Producon Report
1 January .......................................................... 1
2 February ......................................................... 2
3 March ........................................................... 3
4 April ............................................................ 4
5 May ............................................................ 5
6 June ............................................................ 6
7 July ............................................................. 7
8 August .......................................................... 8
9 September ....................................................... 9
10 October ........................................................ 10
11 November ...................................................... 11
12 December ...................................................... 12
13 Subtotals (add lines 1 through 12 in each column) ...................... 13
14 TOTAL (add line 13, columns A and B) .......................................................... 14
LB42
Authorized Signature Date Dayme Phone
Print Name Title
Paid Preparer’s Signature PTIN Date Dayme Phone
I declare that this report is correct and complete to the best of my knowledge and belief.
Mail return to: Minnesota Revenue Mail Staon 3331 St. Paul, MN 55146-3331
Phone: 651-556-3036 Fax: 651-556-5236 Email: alc.taxes@state.mn.us
(Rev. 1/12)
Total Barrels ProducedSign Here
More Than 3.2% 3.2% or Less
(in barrels) (in barrels)
Check if Amended
Company Name FEIN
Address Minnesota Tax ID Number Locaon Code
City State ZIP Period of Return
Print or Type
