CITY OF MARIETTA
Business License Division, 205 Lawrence St., P. O. Box 609
Marietta, GA 30061 Telephone (770) 794-5520
Liquor Sales Reporting Form
Location:
Part A
1. For the Month Ending: (Enter month/day/year) 1._______________
2. Gross Liquor Sales (Enter dollar amount of liquor sales) 2._______________
3. Business License Fee (1% of Line 2) 3._______________
4. Penalty (Line 3 X .1, if postmarked after due date ) 4._______________
5. Interest (Line 3 X .01 X number of months or any part thereof)
Number of months
5._______________
6. Subtotal (Sum of Lines 3, 4 and 5) 6._______________
(Note to liquor package stores only: skip to line 12)
7. Excise Tax (3% of Line 2) 7._______________
8. Penalty (Line 7 X .1, if postmarked after due date ) 8._______________
9. Interest (Line 7 X .01 X number of months or any part thereof)
Number of months
9._______________
10. Deduction * Only if timely (3% of Line 7, not to exceed $25)
Timely? 10._______________
11. Subtotal (Sum of Lines 7, 8 and 9 less Line 10) 11._______________
12. Total Due (Sum of Lines 6 and 11) 12._______________
Part B
Average ounces per drink poured: _______ Average price per drink sold: _______
*This report must be filed and paid by the 20
th
day of the month following the period for which the
tax is due. Take deduction only if timely filed and paid as evidenced by postmark of United States
Postal Service.
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:_______________
Account #:
