PRINT FORM CLEAR FIELDS
67-101
b.
(Rev.5-07/6)
TEXAS MIXED BEVERAGE
GROSS RECEIPTS TAX REPORT Page of
- BUSINESS LOCATION SUPPLEMENT -
You have certain rights under Chapters 552 and 559, Government
73100 Code, to review, request, and correct information we have on file about you.
a. T Code - DO NOT WRITE IN SHADED AREAS
Contact us at the address or toll-free number listed on your report.
c. Taxpayer number d. Filing period e. f. Due date
If any location is out of business or has changed trade name or address, see BUSINESS CHANGES in the instructions.
g. Taxpayer name
Business
TABC Permit location name: Location number:
number:
Address:
1. Dollar amount (retail selling price) of REPORT WHOLE DOLLARS ONLY
.00
complimentary drinks for this location 1.
.00
2. Gross sales of liquor for this location 2.
.00
3. Gross sales of wine for this location 3.
.00
4. Gross sales of beer and malt liquor for this location 4.
5. Gross cover charges (subject to gross receipts tax and not subject to sales tax)
.00
for this location(See instructions) 5.
.00
6. Total gross taxable amount for this location (Total of Items 2, 3, 4, and 5) 6.
Business
TABC Permit location name: Location number:
number:
Address:
1. Dollar amount (retail selling price) of REPORT WHOLE DOLLARS ONLY
.00
complimentary drinks for this location 1.
.00
2. Gross sales of liquor for this location 2.
.00
3. Gross sales of wine for this location 3.
.00
4. Gross sales of beer and malt liquor for this location 4.
5. Gross cover charges (subject to gross receipts tax and not subject to sales tax)
.00
for this location (See instructions) 5.
.00
6. Total gross taxable amount for this location (Total of Items 2, 3, 4, and 5) 6.
Business
TABC Permit location name: Location number:
number:
Address:
1. Dollar amount (retail selling price) of REPORT WHOLE DOLLARS ONLY
.00
complimentary drinks for this location 1.
.00
2. Gross sales of liquor for this location 2.
.00
3. Gross sales of wine for this location 3.
.00
4. Gross sales of beer and malt liquor for this location 4.
5. Gross cover charges (subject to gross receipts tax and not subject to sales tax)
.00
for this location (See instructions) 5.
.00
6. Total gross taxable amount for this location (Total of Items 2, 3, 4, and 5) 6.
TOTALS FOR Total of Item 2 for all locations on this page of Item 3 for all locations on this page of Item 4 for all locations on this Total of Item 5 for all locations on this
Total Total
page page
THIS PAGE 7. 8. 9. 10.
For Items 7, 8, 9, and 10, combine the totals on all business location supplement pages and enter the grand totals
in the corresponding Items 7, 8, 9, and 10 on the \"Texas Mixed Beverage Gross Receipts Tax Report,\" Form 67-100.