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CITY OF MARIETTA
Business License Division, 205 Lawrence St., P. O. Box 609
Marietta, GA 30061 Telephone (770) 794-5520
Malt Beverage Reporting Form
Business Name Account #
Locati
on:
Part A- S
ales for consumption off-premises
1. For the Month Ending: (Enter month/day/year) 1._______________
2. Calculate taxes due.
Container Size
Tax Rate
Quantities
Sold
Taxes Due
Full Barrel
$12.00
x
½ Barrel
$6.00
x
¼ Barrel
$3.00
x
1/6 Barrel
$2.00
x
Case of beer
(twenty-four 12-oz
cans)
$1.20
X
64 oz containers
$0.2667
x
24 oz containers
$0.10
X
16 oz containers
$0.0667
X
12 oz containers
$0.05
x
Other size:
x
Other size:
x
Other size:
x
2. Sum total:
3._______________
4.______________
_
3. Penalty (Line 2 X .1, if postmarked after due date )
4. Outstanding penalties for each successive month or portion thereof.
Number of outstanding months ____________
Total outstanding taxes due
(sum of lines 5 from outstanding ____________ x .1
monthly reports)
5. Total Due (Sum of Lines
2, 3 and 4)
5._______________
*This report must be postmarked by the 10th day of the month following the period for which the
tax is due.
0.00
0.00
1,500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$ 1,500.00
$ 150.00
$ 300.00
$ 1,500.00
500
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I certify that this return, including the accompanying schedules or statements, has been examined by
me and is, to the best of my knowledge and belief, a true and complete return made in good faith for
the period stated. This the ______day of ___________________, 20____.
Return prepared by:_____________________________Title:____________________
Signature:______________________________________Telephone:_______________
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