Page 6 - NABCA 2016 Annual Conference - Shipping Instructions

DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DBPR Form AB&T
4000A-035
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE FL 32399-1022

APPLICATION FOR AND PERMIT TO IMPORT ALCOHOLIC BEVERAGES

I, the undersigned, hereby request permission to bring into the state of Florida for MY PERSONAL CONSUMPTION, the
following alcoholic beverages, for which I am paying the Excise Tax at this time:

MALT: (Beer, Ale, Stout, etc.)

Pints or less @ $ 0.06 per unit =$
per unit =$
Quarts @ $ 0.12 per gallon =$

Bulk Gallons @ $ 0.48

VINOUS: (Wine, Champagne)

Gallons UNDER 17.259% alcohol by volume @ $ 2.25 per gallon = $

Gallons 17.259% OR OVER alcohol by volume @ $ 3.00 per gallon = $

Gallons NATURAL SPARKLING @ $ 3.50 per gallon = $

Gallons CIDER @ $ 0.89 per gallon = $

SPIRITUOUS: (Liquor, Brandy, Cordial, etc.) @ $ 2.25 per gallon = $
Gallons UNDER 17.259% alcohol by volume @ $ 6.50 per gallon = $
Gallons 17.259% - 55.78% alcohol by volume @ $ 9.53 per gallon = $
Gallons OVER 55.78% alcohol by volume

TOTAL EXCISE TAX TO BE REMITTED WITH THIS APPLICATION =$

Beer 003020 - Wine 003025 - Liquor 003030

Name of Applicant Signature of Applicant FL Zip
Address City

DAB&T USE ONLY RECEIPT NO. DATE

State of Florida, County of
Under and by virtue of the authority vested in me by Section 561.11 and 562.15 of the Florida Statutes, and in conformity with the

provisions thereof, I grant permission for the above person to bring into this state the above alcoholic beverages upon which the excise

taxes have been paid.

THIS PERMIT EXPIRES AT MIDNIGHT YEAR

For the By
Director Title

DISTRIBUTION: Original - For U.S. Customs (if needed) Copy - Audit Supervisor

6 | 79th Annual Conference | SHIPPING INSTRUCTIONS