COM/ATT-040 06/19
REQUEST FOR MARYLAND
RELEASE OF FOREIGN BEER
MARYLAND
FORM
040
U.S. Importer
Name Maryland License Number
Street Address
City State Zip Code +4
Maryland Importer
Name Maryland License or Permit Number
Street Address
City State Zip Code +4
FOREIGN BEER: Bottled Canned
BRAND NAME
NUMBER OF
CASES
CONTAINER SIZE
(OUNCES)
GALLONS
PER CASE
TOTAL GALLONS
TOTAL TAX DUE
@$.09/GAL.
$
TOTAL GALLONS
TOTAL TA X DUE
FOREIGN KEG BEER
BRAND NAME
NUMBER OF
KEGS
CONTAINER SIZE
GALLONS
PER KEG
TOTAL GALLONS
TOTAL TAX DUE
@$.09/GAL.
$
TOTAL GALLONS
TOTAL TA X DUE
Oce Use Only
Check Number __________
Amount $ _____________
Deposit Date ___________
TOTAL TAX DUE: ..................................................................$
AMENDED
Remittance shall be in the form of Direct Debit at www.marylandtaxes.gov, Check or Money Order Payable to: COMPTROLLER OF
MARYLAND
The foreign beer released will only be shipped directly to an authorized Maryland Importer.
_____________________________________________________________________________
Signature U.S. Importer
Print Name
Email Address
Date
SEND RELEASE FOR FOREIGN BEER TO:
Name
Street Address
City State Zip Code+4
Contact Information:
Comptroller of Maryland
Revenue Administration Division
Returns Processing
Alcohol Tax Office
PO Box 2999
Annapolis, MD. 21404-2999
Telephone: 410-260-7127 or 800-638-2937
Fax: 410-260-7924