This document is from the Nevada Department of Taxation regarding a liquor wholesaler's monthly report of sales to airlines for an excise tax credit. It provides instructions for the wholesaler to list on attached invoices the date, airline name, and gallons of malt beverages and alcoholic beverages of varying alcohol percentages sold for export from Nevada. The wholesaler must then sign and date the form before entering the total eligible for a tax credit on their tax return.

1. NEVADA DEPARTMENT OF TAXATION
TID NO:
__
1550 COLLEGE PARKWAY, STE 115
(Enter 10 digit Taxpayer ID# followed by 3 digit location #)
CARSON CITY, NEVADA 89706
For the Month of _________________________
LIQ-4b (05/07)
SUPPLEMENTAL PAGE TO LIQ-1

2. LIQUOR WHOLESALER MONTHLY REPORT OF SALES TO AIRLINES
Firm Name
Street
City State Zip Code
Excise tax credit (Line 4b on LIQ-1) for alcoholic beverages exported from the State of Nevada
(NRS 369.175)
Attach copies of all supporting invoices.
DATE NAME OF AIRLINE
MALT BEVERAGES ALCOHOLIC BEVERAGES
KEG
GALLONS
BOTTLE
OR CAN
GALLONS
GALLONS
.5% to 14 %
GALLONS
14.1% to 22%
GALLONS
22.1% to 80%
GALLON TOTALS:
LESS .5% FORMERLY DISCOUNTED:
LIQ-4b (05/07)
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3. TOTAL, ENTER ON LINE 4b OF TAX RETURN:
The above information is true and correct to the best of my knowledge and belief.
Signed.................................................................................
Title......................................................................................
Date ……………………….......
LIQ-4b (05/07)
SUPPLEMENTAL PAGE TO LIQ-1