MARYLAND
FORM
022
REPORT OF PRODUCTION
OF ALCOHOL FOR FUEL
USE (NON-COMMERCIAL OR
EXPERIMENTAL)
Page 1
Note: ThisformcoversactivityofaFuel-AlcoholpermitholderfromNovember1throughOctober31annuallyandmustbeled
byNovember15subsequenttothereportperiod.Failuretolethisreportinatimelyfashionwillsubjectthepermitto
suspension or revocation proceedings.
Signature Title:Owner,PartnerorOcer Date
Undenatured Alcohol Denatured Alcohol
A. Total Gallons of Alcohol on Hand at Beginning of Year ................. ___________________
_____________________
B. TotalGallonsofAlcoholProducedDuringYear ....................... ___________________
_____________________
C. TotalGallonsofAlcoholDenaturedDuringYear ...................... ___________________
_____________________
D. TotalGallonsConvertedtoFuelUseDuringYear ..................... ___________________
_____________________
E. Total Gallons of Alcohol on Hand at End of Year ...................... ___________________
_____________________
Contact information:
Comptroller of Maryland
FieldEnforcementDivision
Regulatory & Licensing
Section
P.O. Box 2999
Annapolis,Maryland21404-2999
410-260-7314or800-MD-TAXES
ATT@
marylandtaxes.gov
www.marylandtaxes.gov
Printed name
COM/FED/RLS-022
October31,20___
For period ending:
Name of Permit Holder
Street Address
City State Zip Code
Email Address
Type of Apparatus
TypeofMash TypeofDenaturantUsed
Fermenting Cycle of Mash Total Capacity of Fermenters in Gallons Capacity of Apparatus in Gallons
OperatingPeriodofApparatus DailyProductionCapacityinGallons