Request For Maryland Release Of Foreign Beer {ATT-40}

MARYLAND FORM 040 REQUEST FOR MARYLAND RELEASE OF FOREIGN BEER Office Use Only Check Number __________ Amount $ _____________ Deposit Date ___________ Maryland License Number Request will not be honored unless this form is completed . U.S. Importer Name Street Address City State Zip Code Maryland Importer Name Street Address City State Zip Code Maryland License or Permit Number FOREIGN BEER: BRAND NAME Bottled Canned NUMBER OF CASES CONTAINER SIZE (OUNCES) GALLONS PER CASE TOTAL GALLONS TOTAL TAX DUE @$.09/GAL. $ TOTAL GALLONS TOTAL TAX DUE FOREIGN KEG BEER BRAND NAME NUMBER OF KEGS CONTAINER SIZE GALLONS PER KEG TOTAL GALLONS TOTAL TAX DUE @$.09/GAL. $ TOTAL GALLONS TOTAL TAX DUE TOTAL TAX DUE: ALL FOREIGN BEER ­ AMOUNT OF CERTIFIED CHECK HEREWITH . . . . . . . . . . . . . . . . . . . $ SEND RELEASE FOR FOREIGN BEER TO: Business Name Street Address City State Zip Code Make checks payable to: Comptroller of Maryland Send remittance to: COMPTROLLER OF MARYLAND Revenue Administration Division Alcohol Tax P .O . Box 2999 Annapolis, MD 21404 410-260-7127 or 1-800-638-2937 Fax: 410-260-7924 The foreign beer released will only be shipped directly to an authorized Maryland Importer . Signature _______________________________________________________________________ U .S . Importer COM/ATT-040 04/17 American LegalNet, Inc. www.FormsWorkFlow.com