Excise Duty Return Licensed User

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Helen Johnson
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1 Excise Duty Return Licensed User Mailing address City Send this completed return to: Canada Revenue Agency Prince Edward Island Tax Centre 275 Pope Road Summerside PE C1N 6E7 Province Postal code 3 Due date (YYYY-MM-D Products (according to percentage of absolute ethyl alcohol by volume) Quantity (litres of absolute ethyl alcohol/litres) Code Duty payable Spirits containing more than 7% Spirits containing not more than 7% Wine containing more than 7% Wine containing more than 1.2%, but not more than 7% Wine containing not more than 1.2% tal (4 to 8) Refunds (B256 attached) Net payable (9 minus 10) Amount due Payment / Credit due Certification I,, Print name certify that the information in this return is, to the best of my knowledge, correct and complete. Title, Signature Date (YYYY-MM-D Telephone number Ext. Note: You can authorize a business representative through My Business Account or by sending us a completed Form RC59, Business Consent. Go to canada.ca/en/revenue-agency/services/tax/businesses/topics/registering-your-business/authorize-a-representative-business-number for more information. Form prescribed by the Minister of National Revenue B263 E (16) (Ce formulaire est disponible en français.) Page 1 of 5

2 Corrected or new name of licensee (Please print) Change of name or address, or both New mailing address (Please print) New address for books and records (Please print) New contact name (Please print) Title (Please print) New telephone number Ext. Language of communication English French Effective date of above change(s) Year Month Day Business closed as of Reason Year Month Day Tick the proper box to get Remittance vouchers Additional material required Return envelope (pre-addressed) GST394 Remittance envelope (Blue band) T1190 Page 2 of 5

3 Containing more than 7% absolute ethyl alcohol Spirits Containing not more than 7% Opening inventory Domestic spirits Imported spirits tal additions Restricted Other Used to produce vinegar fortify wine Returned to spirits licensee or excise warehouse licensee Exported spirits Used in processes Removed for other purposes (specify) tal reductions Inventory adjustments (+ or ) Closing inventory (A + C ± D Page 3 of 5

4 Containing more than 7% Wine Containing more than 1.2%, but not more than 7% Containing not more than 1.2% Opening inventory Domestic wine Imported wine tal additions Restricted Other Used to produce vinegar Blended with spirits to produce spirits Returned to wine licensee or excise warehouse licensee Exported wine Used in processes Removed for other purposes (specify) tal reductions Inventory adjustments (+ or ) Closing inventory (A + C ± D Page 4 of 5

5 Restricted s Opening inventory 00 Restricted produced 00 Received from licensed users 00 Imported restricted 00 tal additions 00 Restricted 00 Other 00 Removed to another licensed user 00 Exported 00 tal reductions 00 Inventory adjustments (+ or ) 00 Closing inventory (A + C ± D 00 Personal information provided on this form is protected under the provisions of the Privacy Act and is maintained in Personal Information Bank CRA PPU 224. Page 5 of 5

Mail This Form to: Service Nova Scotia Business Registration Unit PO Box 1529 Halifax, Nova Scotia B3J 2Y4. Business Applicant Profile Information

Mail This Form to: Service Nova Scotia Business Registration Unit PO Box 1529 Halifax, Nova Scotia B3J 2Y4 Business Applicant Profile Information Business Name: Operating Name Canada Revenue Agency BN