GROSS ANNUAL REVENUE REPORTING

Used for Restaurant and Entertainment Classifications ONLY

This form will be used by the establishment to provide data from the previous calendar year (January to December). Establishments must provide gross revenue reports, detailed by category of revenue generated on a per-month basis and showing the percentage of alcohol revenue generated by the establishment. NOTE: Additional financial details of said gross revenues shall be made available upon request by the City.

Breakdown of Revenue Categories and Monthly Gross Revenue per Category

In addition to Alcohol, categories of revenue may include food, merchandise sales, etc. If more than 6 categories of revenue per month are applicable, please include the 6 categories with the highest revenue and then email cityclerk@cityblm.org with a list of all categories and revenue amounts.

NOTE: Each establishment may have different categories. All categories of revenue must be included as separate items.

Business Information

Legal Name of Establishment: *

DBA (Assumed Name): *

Email for ALL Licensing Communication:

JANUARY 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Total Revenue for January 2023:

FEBRUARY 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Total Revenue for February 2023:

MARCH 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Total Revenue for March 2023:

APRIL 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Total Revenue for April 2023:

MAY 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Total Revenue for May 2023:

JUNE 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Total Revenue for June 2023:

JULY 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Total Revenue for July 2023:

AUGUST 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Total Revenue for August 2023:

SEPTEMBER 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Total Revenue for September 2023:

OCTOBER 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Total Revenue for October 2023:

NOVEMBER 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Total Revenue for November 2023:

DECEMBER 2023

Category Alcohol Amount:

Category 2 Name:

Category 2 Amount:

Category 3 Name:

Category 3 Amount:

Category 4 Name:

Category 4 Amount:

Category 5 Name:

Category 5 Amount:

Category 6 Name:

Category 6 Amount:

Email Address for ALL City Communication

Signature of Authorized Agent or Representative.

First Name

Last Name

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