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2. Quarter End Date:*
4. Name of Business:*
6. Address1
8. City
9. State
10. Zip
12. Gross receipts from malt beverage package sales.*
14. Regulatory fee - 7% of sales:*
16. Less credit allowed ($200.00 license fee can be taken one time a year as credit)
18. Penalty for late payment - 5% :($10.00 minimum, 25% maximum)
20. Subtotal - Regulatory Fee Due*
22. Signature/Date*
24. Pay Schedule

    1st quarter: July - Sept  Due Oct 31st

    2nd quarter: Oct - Dec   Due Jan 31st

    3rd quarter: Jan - March  Due April 30th

    4th quarter: April - June  Due July 31st

    Remit check or money order payable to: 

    City of Georgetown c/o ABC Administrator

    100 N. Court Street, Georgetown Ky, 40324

    Fees can also be paid on our website at www.georgetownky.gov 

    
    

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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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