A Return MUST Be filed Each Month Whether or Not Liquor Is Imported/Manufactured

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NEVADA DEPARTMENT OF TAXATION TID: - LIQUOR EXCISE TAX RETURN (10 digit Taxpayer ID# and 3 digit location #) Mail original to: Nevada Department of Taxation 1550 College Parkway, Room 115 Carson City, NV 89706 FOR MONTH ENDING: DUE ON OR BEFORE: If postmarked after the due date, penalty and interest will apply. If the name or address shown is incorrect, if the ownership or business location has changed, or if you are out of business, notify the Liquor Excise Tax Examiner in the Carson City District Office immediately. A Return MUST Be filed Each Month Whether or Not Liquor Is Imported/Manufactured TRANSACTIONS DURING THE MONTH IN 1. Total Imports into Nevada MALT BEVERAGE ALCOHOLIC BEVERAGES OFFICE USE ONLY Keg or Bottled or Total Malt.5% to 14% 14.1% to 22.1% to Draught Canned Beverage 22% 80% Postmark: 2. Credit: Breakage, Loss- LIQ-2 3. Credit: Exports/Sales- LIQ-3 or manufactured in the State 4a. Credit: Military Sales- LIQ-4a 4b. Credit: Airline Sales- LIQ-4b 5. TOTAL DEDUCTIONS Ck. No: Date: $ Initials: 6. TOTAL TAXABLE 7. Tax Rates for liquor categories $.16 per gal. $.70 per gal. $ 1.30 per gal. $ 3.60 per gal. 8. Gross Tax (taxable gallons times tax rate) $ 9. Discount of 0.25% allowed if payment is postmarked on or before the 15 th of the month following activity 10. Adjusted Tax amount due and payable with this return $ 11. Less credits approved by the Department. Credit notification from the Department must be attached. - 12. Penalty (see instructions for rate) For periods prior to April 1, 2007 the penalty is 10%. $ 13. 1% interest per month due on payments postmarked after the 20 th of the month $ 14. Add Liabilities established by the Department $ 15. Total amount due and payable. $ 16. Total amount remitted with this return. MAKE CHECK PAYABLE TO THE NEVADA DEPARTMENT $ OF TAXATION Should corrections or adjustments be necessary on previously filed monthly returns: a. On a copy of an incorrect return, indicate if it is an Amended return. - 1 - LIQ-1 -

b. Draw a single line through the figure that is to be adjusted. c. Enter the correct figure either above or below the figure that is to be corrected. d. Adjust extensions for corrected totals. e. Apply appropriate Penalty and Interest. f. Include a note describing the reason for the correction. I hereby certify that this return, including all attached schedules has been examined by me and to the best of my knowledge and belief is a true, correct and complete return; that I am the Importer, Manufacturer, or Officer of the above business and duly qualified and authorized to verify this return. Reported By Checked by d Signe Title Phone No LIQUOR EXCISE TAX RETURN INSTRUCTIONS Line 1 Enter the total gross monthly imports, in gallons to the hundredth (2 decimal places), to be verified by supplier reports. Manufacturers must include copies of TTB tax returns. Line 2 Credit for shipments lost, stolen or damaged in transit, or damaged or spoiled on the premises less the 0.5% discount taken previously if the tax was paid prior to 1/1/09. If the tax was paid after 1/1/09 the discount will be 0.25%. List on Form LIQ-2. Line 3 Credit for liquor exported and sold outside this State and/or liquor purchased from a manufacturer, rectifier, or brewer in this state less 0.5% discount taken previously if the tax was paid prior to 1/1/09. If the tax was paid after 1/1/09 the discount will be 0.25%. List on Form LIQ-3 and enclose a copy of the original invoice with this report. Line 4 Credit for liquor sold to airlines, permissible persons or to military installations less 0.5% discount taken previously if the tax was paid prior to 1/1/09. If the tax was paid after 1/1/09 the discount will be 0.25%. List on supplemental Form LIQ-4a or LIQ-4b. Line 5 Total of lines 2-4b Line 6 Subtract quantity on line 5 from quantity on line 1 for total taxable gallons. Line 8 Line 9 Line 10 Line 11 Line 12 Line 13 Line 14 Lien 15 Multiply gallons shown on line 6 by tax rate shown on line 7 for the gross tax. The excise tax imposed by this Chapter is due and payable on or before the 20 th day of the following month. If all such taxes are paid on or before the 15 th day of the following month, a discount in the amount of 0.5% of the tax shall be allowed. If tax is not paid by date due a penalty of 10% will be added, together with interest at the rate of 1% per month, or any fraction thereof, from the date due until paid. Subtract figure on line 9 from gross tax on line 8 for adjusted tax amount. Subtract credits (attach Department notification of credit to this return). If this return will not be submitted/postmarked and the taxes paid on or before the due date as shown on the face of this return, the amount of penalty due is based on the number of days late the payment is made per NAC 360.395. The maximum penalty amount is 10%. Number of days late Penalty Percentage Multiply by: 1-10 2% 0.02 11-15 4% 0.04 16-20 6% 0.06 21-30 8% 0.08 31 + 10% 0.10 Determine the number of days late the payment is, and multiply the net tax owed by the appropriate rate based on the table above. The result is the amount of penalty that should be entered. For example, the taxes were due January 31, but not paid until February 15. The number of days late is 15 so the penalty is 4%. Add 1% interest per month, or fraction thereof, if postmarked after the 20 th of the month following activity. Add amount of any Liability that has been established by the Department. Attach Department notification of amount due. Total amount due and payable with this return. ** For up-to-date information on tax issues, be sure to check our website -- http://tax.state.nv.us/ -- ** every January, April, July and October for Tax Notes articles. - 2 - LIQ-1

- 3 - LIQ-1

TID: - (10 digit Taxpayer ID# and 3 digit location #) BEER, WINES AND LIQUORS IMPORTED INTO NEVADA, NOT WITHDRAWN FROM BOND INCLUDE COPIES OF ALL INVOICES FROM SUPPLIERS WITH THIS RETURN (ENTER LIQUOR WITHDRAWN FROM BOND ON PAGE 4) Invoice Date Supplier s Name Certificate of Compliance Holder Certificate Number Invoice Number Beer Gallons.5 through 14% Gallons 14.1 to 22% Gallons 22.1 to 80% Gallons Subtotal of Imports NOT from Bond - 4 - LIQ-1

TID: - (10 digit Taxpayer ID# and 3 digit location #) BEER, WINES AND LIQUORS IMPORTED INTO NEVADA, NOT WITHDRAWN FROM BOND INCLUDE COPIES OF ALL INVOICES FROM SUPPLIERS WITH THIS RETURN (ENTER LIQUOR WITHDRAWN FROM BOND ON PAGE 4) Invoice Date Supplier s Name Certificate of Compliance Holder Certificate Number. Invoice Number Beer Gallons.5 through 14% Gallons 14.1 to 22% Gallons 22.1 to 80% Gallons Subtotal Imports NOT from Bond Total Imports NOT from Bond Plus Total Imports from Bond Grand Total Imports. Enter on Line 1, Page 1-5 - LIQ-1

TID: - (10 digit Taxpayer ID# and 3 digit location #) ALCOHOLIC BEVERAGES ENTERED AND WITHDRAWN FROM BONDED WAREHOUSES Name of Supplier Purchased From Bond No. Name or Type of Liquor Date Gallons Total Withdrawn Withdrawn Including Losses Name of Bonded Warehouse, Broker, etc. Invoice No. Percent Alcohol Original Gallons This Month Balance in Bond Total Imports from Bond ENTER TOTALS FROM BOND UNDER PROPER CATEGORY AT BOTTOM OF PAGE 4-6 - LIQ-1

NEVADA DEPARTMENT OF TAXATION TID: - 1550 COLLEGE PARKWAY, STE 115 (10 digit Taxpayer ID# and 3 digit location #) CARSON CITY, NEVADA 89706 For the Month of LIQUOR IMPORTER/WHOLESALER MONTHLY REPORT OF LOSS Firm Name: Street: City: State: Zip Code: DATE Excise tax credit (Line 2, LIQ-1) for alcoholic beverages lost, stolen or damaged in transit or on premises. (NRS 369.370) Attach copies of all supporting loss claims which have been filed with carriers, shippers, etc. EXPLAIN TYPE OF LOSS, SHIPPER, BRAND NAME, ETC. MALT BEVERAGES BOTTLE KEG OR CAN. 5% to 14% ALCOHOLIC BEVERAGES 14.1% to 22% 22.1% to 80% GALLON TOTALS: LESS.25% FORMERLY DISCOUNTED: TOTAL, ENTER ON LINE 2 OF TAX RETURN: The information above is true and correct to the best of my knowledge and belief. Signed Title 1 Date - 7 - LIQ-2 SUPPLEMENTAL PAGE TO LIQ-

NEVADA DEPARTMENT OF TAXATION TID: - 1550 COLLEGE PARKWAY, STE. 115 (10 digit Taxpayer ID# and 3 digit location #) CARSON CITY, NEVADA 89706 For the month of LIQUOR IMPORTER/WHOLESALER MONTHLY REPORT OF EXPORTS Firm Name: Street: City: State: Zip Code: Excise tax credit (Line 3 on LIQ-1) for alcoholic beverages exported from the State of Nevada or manufactured in the State of Nevada (NRS 369.370) State Exported to A copy of this report must be filed for each State that liquor is exported to. Manufacturer purchased from DATE NAME AND ADDRESS WHERE SHIPMENT IS MADE CITY MALT BEVERAGES KEG BOTTLE OR CAN. 5% to 14% ALCOHOLIC BEVERAGES 14.1% to 22% 22.1% to 80% GALLON TOTALS: LESS.25% FORMERLY DISCOUNTED: TOTAL, ENTER ON LINE 3 OF TAX RETURN: The information above is true and correct to the best of my knowledge and belief. Signed Title 1-8 - LIQ-3 SUPPLEMENTAL PAGE TO LIQ-

Date 1-9 - LIQ-3 SUPPLEMENTAL PAGE TO LIQ-

NEVADA DEPARTMENT OF TAXATION TID: - 1550 COLLEGE PARKWAY, STE. 115 (10 digit Taxpayer ID# and 3 digit location #) CARSON CITY, NEVADA 89706 For the Month of LIQUOR WHOLESALER MONTHLY REPORT OF MILITARY SALES Firm Name: Street: City: State: Zip Code: DATE Excise tax credit (Line 4a on LIQ-1) for alcoholic beverages sold to MILITARY UNITS in Nevada, who qualify as Instrumentalities of the Armed Forces of the United States (NRS 369.335) Attach copies of all supporting invoices. NAME AND LOCATION SHIPPED TO BASE, POST, STORE, INSTALLATION MALT BEVERAGES KEG BOTTLE OR CAN.5% to 14% ALCOHOLIC BEVERAGES 14.1% to 22% 22.1% to 80% GALLON TOTALS: LESS.25% FORMERLY DISCOUNTED: TOTAL, ENTER ON LINE 4a OF TAX RETURN: The information above is true and correct to the best of my knowledge and belief. Signed Title Date - 10 - LIQ-4a SUPPLEMENTAL PAGE TO LIQ-1

NEVADA DEPARTMENT OF TAXATION TID: - 1550 COLLEGE PARKWAY, STE. 115 (10 digit Taxpayer ID# and 3 digit location #) CARSON CITY, NEVADA 89706 For the Month of LIQUOR WHOLESALER MONTHLY REPORT OF SALES TO AIRLINES Firm Name: Street: City: State: Zip Code: DATE 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. MALT BEVERAGES ALCOHOLIC BEVERAGES NAME OF AIRLINE KEG BOTTLE OR CAN.5% to 14 % 14.1% to 22% 22.1% to 80% GALLON TOTALS: LESS.25% FORMERLY DISCOUNTED: TOTAL, ENTER ON LINE 4b OF TAX RETURN: The information above is true and correct to the best of my knowledge and belief. Signed Title Date - 11 - LIQ-4b SUPPLEMENTAL PAGE TO LIQ-1

- 12 - LIQ-4b SUPPLEMENTAL PAGE TO LIQ-1