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Utah State Tax Commission

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TC-393
Rev. 11/94

Transporter's Report of Imported Beer
Mail to: Auditing Division, Utah State Tax Commission, 210 North 1950 West, Salt Lake City, UT 84134
Name Address Account number Month

20 ____
Date Bill-of-lading or Reference number Number of cases and barrels Name and address of brewery from whom received Destination Consignee and address Point of Delivery 24/ 11 oz. 24/ 12 oz. 12/ 32 oz. 1/4 BBL 1/2 BBL 1/1 BBL

Total packages (Cases or kegs)

I certyify that this report, including any accompanying schedules, have been examined by me and to the best of my knowledge is a true, correct and complete report.
Signature Date signed Title Telephone Number

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Print Form TC-393.CDR 11/94