For IR Use rie acs! mina @ eae Rance ras EXCISE TAX RETURN SIR Form No for Alcohol Products 2200-A rece lermatan CAPIALLETIERS ving WACK Marta sccode Ap 2014 (ENCS) [Date pawoonrrrr, 7 1 [aAmended Retum?]]Yes[—]No 3 Number of Shoots Atached Pant = Gackground information “4 Taxpayer Kentfcaton Number (FIN) | Jt, [sR00Ge0 | 6 Taxpayers Name (Lest Hone, st aa ile Ras ai Rogod Rane oe ReaD RSS ee ae a pooper L AZ Gada] B contaet Nomber ‘Main Line of Business TOPs i Ema Adres pi 7a Prace of Production Region | Provnes mn 7s Place of Removal Region | Prownes: are ya avaing oF aX gE andor Spal Caw oF | aA yo Spay Intemational Tax Treaty? L_] Yes [_] No 1 Par i= Manner OF Payment 15 |_| Payment on Actual Removal 16 [_] Prepayment/Advance Deposit TTL] Other Siar Schemes feat] Parti = Payments and Application 18 Excise Tax Due (rom Schedule 1) 719 Less: 19A Balance Carried Over from Previous Return 198 Greditable Excise Tax, appleable 7180 Total (Sun oon 194 & 795) 20 Net Tax Due/(Overpayment) tem raiess tam 190) 24 Lest Payment on Returns Proviosly led for be Sar Parod areanded rum 22 Tax Sil Duel(Overpayment) er 20/655 tom 21) 23 Addi Penatios 23A Surcharge 238 Inorest 23C Compromise 28D Total Penalties (Sum oem 294 0 236), ‘24 Amount Payable (Sum of ems 22 & 230) 25 Lass. Paynent Made Today 25A Tax PaymenUDepasit 258 Penalties (rom hem 220) 256 Total Payrent Made Today (Sim of ar 5A 6258) 126 Balance to be Carried Over to Next Retum (er 24 lesser 256) | aaa ER Se ne an ea TTT Part IV=Detale of Payment. Particulars [bare Baki] Number Date (an anvVW Amount aT cumveancoetivens] L L A ze check pi L L WW 29 Tax Debi Memo 1 CO ea SDE aoeaty Wy Wt fi Ta RAE TRE TT Ra TaSTAGT A tb 797 OREATAE and De of FE ‘Sgnouraank Toor ia =)r Ura ared IM ate Description Tea a 2) babe Taxes bam nt Net en pert ox nit of Measure Basic Excee Tax Due {exces aaa VA x0 Efe Jey 1,20] NRP Per Poot [15H Ente Jay 12075 2 Eerie rua 12016 2 ese rua 12017 2 yon a Va Ta PE ce Ra LIT zm xo36 Etec run 1 2014 | Per Prot tr [20,00 Efecve rua 12015 20 Ties Senin wna ten Nie atdng eae ada oe eet st meus cae, ‘arse pot xa Pepto res Porbter Ec rua 201 ra Efecive Jruary 2014 25000 ets Jay 12015 oat ce rua 12017 22a ass an Pip 6090 Eee ISS TAT] pg jgqy [728 ee ce eras 12075 au 7512 TT ira erandra ‘Seog tek fatty re ec ray 12013 HH oro Efecrve rusty 2014] Peruter [31.20 tvs Jay 12015 S75 ce rua 12017 3.0 Ty Sweat neat ws nny mre bby ‘eke bararam an fa pec ere peu Le ‘SEE e 7 cee = eaoao| ¢) Fatadres consineg mor Ms"25%) es proot iter | Semen Paes ne stem es ees xaos Effective January 1.2013 | PerLiter == oar = SEE aa a fective January 1, 2013 | aa heave Jan 24 aaa | swim Ee ae esr orl joo! —— ST rum RR a a8 ae TOTAL TAXDUE fo hem 79 L ferent) =]