73A525 (7-24)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
TEAM KENTUCKY
FOR DEPARTMENT USE ONLY
* Tax * / Mo. / Yr.
File with the Department of Revenue on or before the 20th of the month following the month for which the report is made.
Name and Address of Distiller, Rectifier or Bottler Revenue Account Number ________ State License Number ________ Report for Month of _______, 20______
Part I—Distilled Spirits Excise Tax Report Number of Cases
3 Gal. 2.4 Gal. 12 Liters 10.5 Liters 9.6 Liters 9 Liters 1 Gallon Other (specify)
Gift Shop or other retail outlet sales to consumers and retailers in Kentucky (per instructions).................................................
Samples taken from Kentucky inventory.........................................................
Other (per instructions).................................................
Total amount due (add lines 9 and 10)................................................. $ $
☐ Check the box if Tax Type 20 Excise Tax was paid online. (Payment ID# _______ )
Total subject to excise tax (add lines 1, 2 and 3).................................................
Less quantities returned by retailers and consumers (complete schedule on reverse side) ..
Balance subject to excise tax (line 4 minus line 5).................................................
Tax rate per case................................................. $ 5.76 $ 4.61 $ 6.09 $ 5.33 $ 4.87 $ 4.57 $ 1.92
Excise tax applicable (line 6 multiplied by line 7)................................................. $ $ $ $ $ $ $ $ $ $ $ $
Total excise tax due (total of all items on line 8)................................................. 20 $
Penalty and interest due (per instructions)................................................. $ $
Part II—Distilled Spirits Wholesale Sales Tax Report
Gross receipts from wholesale sales of spirits to consumers and retailers in Kentucky (excluding 11% wholesale sales tax)................................................. $ $
Total wholesale sales tax due (line 12 multiplied by .11)................................................. 22 $
Penalty and interest due (per instructions)................................................. $ $
Total amount due (add lines 13 and 14)................................................. $ $
☐ Check the box if Tax Type 22 Wholesale Sales Tax was paid online. (Payment ID# _______ )
Part III—Distilled Spirits Case Sales Tax Report (Note: This Part applies to self-distributed sales by Class B distillers only)
Cases subject to tax (total number of cases included in line 1 of Part I above self-distributed by Class B distillers)................................................. $ $
Total case sales tax due (line 16 multiplied by .05)................................................. 19 $
☐ Check the box if Tax Type 19 Distilled Spirits Case Sales Tax was paid online. (Payment ID# _______ )
Part IV—Total Amount Due with Monthly Report of Distillers, Rectifiers or Bottlers
Total distilled spirits excise, wholesale sales, and case sales tax due (add lines 11, 15, and 17)................................................. $ $
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