HomeMy WebLinkAboutForm - Report of Gross Revenue of Food and Beverage Sales (FY25-26) - FillableDEPARTMENT OF LIQUOR CONTROL COUNTY OF HAWAI‘I
SUBJECT TO AUDIT FY25-26
Hilo Lagoon Centre, 101 Aupuni Street, Unit 230, Hilo, Hawai‘i, 96720 * Phone: (808) 961-8218 * Fax: (808) 961-8684
E-mail: cohdlc@hawaiicounty.gov
REPORT OF GROSS REVENUE OF FOOD AND BEVERAGE SALES
DEADLINE: Friday, April 17, 2026
I. Quarterly Gross Revenues from JULY 1, 2025 through SEPTEMBER 30, 2025
Food Sales: $
Liquor Sales: $
Gross Revenues: $
II. Quarterly Gross Revenues from OCTOBER 1, 2025 through DECEMBER 31, 2025
Food Sales: $
Liquor Sales: $
Gross Revenues: $
III. Quarterly Gross Revenues from JANUARY 1, 2026 through MARCH 31, 2026
Food Sales: $
Liquor Sales: $
Gross Revenues: $
I declare, under the penalties set forth in Chapter 281, Hawai‘i Revised Statutes, as amended, that this report has been
examined by me and is a true, correct, and complete report, pursuant to Chapter 281 and the Rules and Regulations of
the Liquor Commission County of Hawai‘i.
Date:
SIGNATURE OF LICENSEE OR AUTHORIZED AGENT
PRINTED NAME AND TITLE
PHONE NO E-MAIL ADDRESS
1. Pursuant to Rule 4-7-A-5, all Class 2 (Restaurant) Licensees must show that food sales are at least 30% of
the total gross revenues during this period.
2. This report must be signed by the licensee or by an authorized agent, in the case of a corporation filing (if
filing by mail). If filing electronically, please type name in signature block.
3. Please return the completed form to us via mail, fax or e-mail by the given deadline. If filing electronically,
no hard copy is needed.
ENTITY NAME:
DBA NAME:
LICENSE NO: