Nonresident Sellers Report {C-205}

FORM C-205 (0/1) TABC USE ONLY ENTRYCHECKED STATE: UNITSWINE 14%WINEWINEDISTILLEDDISTILLEDDATENUMBERAND LESSOVER 14%SPARKLINGSPIRITSMINI's (20-60ml)TitleDate GALLONS TOTAL AFFIRMATION,Underpenaltyofperjury,IswearIamanofficerorauthorizedrepresentativeoftheabovePermittee,andIhaveexaminedthisreport,andconfirmitistrue,correct,andcomplete. Signature E-Mail Address INSTRUCTIONS:Thisformandanyattachmentsmustbefiledonorbeforethe15thdayofthemonthfollowingeachreportingperiod.MailtoTABC,POBOX13127,AUSTIN, TX78711-3127orsubmitelectronicallytothee-mailaddressbelow.Retainonecopyforyourfilesforaperiodoffouryears.Aslongasyourpermitremainsactive,youmustfileareportevenifnobusinesswasconducted.Alegiblecopyofeachinvoicemustbesubmittedtosupporteachentry.Eachinvoicemustshowtotalgallonsofeachclass of liquor shipped, excluding total units of distilled spirit miniatures (20-60ml). For assistance, please contact the Tax Division at (512) 206-3342 or excise.tax@tabc.state.tx.us . NONRESIDENT SELLER'S REPORT Monthly Report of Wine and Distilled Spirits Shipped into the State of Texas During the Month/Year of: INVOICETRADE NAME: ADDRESS: CITY: ZIP CODE: PHONE NUMBER: PERMIT NUMBER: S **REPORT IS DUE ON THE 15TH DAY OF THE MONTH FOLLOWING EACH REPORTING PERIOD** TX WHOLESALER or WINERY CITY American LegalNet, Inc. www.FormsWorkFlow.com FORM C-205 (06/12) UNITS WINE 14% WINEWINEDISTILLEDDISTILLEDDATENUMBERAND OVEROVER 14%SPARKLINGSPIRITSMINI's (20-60ML) INVOICE GALLONS TX WHOLESALER or WINERY CITY American LegalNet, Inc. www.FormsWorkFlow.com