City of Florence Alabama

RETAIL LIQUOR GROSS RECEIPTS TAX REPORT

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Report for the month of

Report for the month of *

, 20

Complete all information that applies to your business and remit this form along with your check by the 15th day of the month, for the preceding month's sales. A 15% penalty should be added if not personally submitted or postmarked on or before the 15th day of the month.

To obtain and retain a Restaurant Liquor License, food sales must amount to more than 50% of your gross sales.

The taxable rate shall be 5% on gross retail liquor sales.

A. TOTAL GROSS SALES WITHIN THE FACILITY.................................

(INCLUDING ALL LIQUOR, BEER, WINE, FOOD, AND MISCELLANEOUS)

A. TOTAL GROSS SALES WITHIN THE FACILITY

B. LESS GROSS BEER AND WINE SALES.................................

B. LESS GROSS BEER AND WINE SALES

C. LESS GROSS FOOD SALES.................................

C. LESS GROSS FOOD SALES

D. LESS ALL OTHER MISCELLANEOUS SALES.................................

D. LESS ALL OTHER MISCELLANEOUS SALES

E. GROSS TAXABLE RETAIL LIQUOR SALES.................................

E. GROSS TAXABLE RETAIL LIQUOR SALES

F. RETAIL LIQUOR TAX (LINE E TIMES 5%).................................

F. RETAIL LIQUOR TAX (LINE E TIMES 5%)

G. LATE PENALTY (LINE F TIMES 15%).................................

G. LATE PENALTY (LINE F TIMES 15%)

H. TOTAL TAX DUE CITY OF FLORENCE (LINE F PLUS LINE G).................................

H. TOTAL TAX DUE CITY OF FLORENCE (LINE F PLUS LINE G)

Please make checks payable to the City of Florence and mail to:

City of Florence

Office of City Clerk

P.O. Box 98

Florence, AL 35631

The information furnished herein shall be considered confidential in nature and shall not be divulged to anyone other than the Mayor, City Council, City Clerk, and City License Inspectors.

I hereby certify that the information contained herein has been examined and is true and correct.

NAME OF BUSINESS

ADDRESS