ATT-7 SP (08/11) RETURN TO BE FILED ON OR BEFORE THE 15 TH DAY OF THE FOLLOWING MONTH FOR WHICH THE REPORT IS FILED. SUBMIT REPORT AND REMITTANCE TO: GEORGIA DEPARTMENT OF REVENUE PROCESSING CENTER P.O. Box 105458 ATLANTA, GA 30374-5458 GEORGIA SPECIAL ORDER SHIPPING LICENSE MONTHLY EXCISE TAX RETURN NAME OF WINERY LICENSE NO. ADDRESS FOR CALENDAR MONTH/YEAR OF: CITY/STATE ZIP CODE REPORT IN LITERS SALES TO GEORGIA CONSUMERS DURING THE CALENDAR MONTH INVOICE DATE INVOICE NO. FULL NAME AND ADDRESS OF CONSUMER WINE PRODUCED OUTSIDE GEORGIA 14% OR LESS OVER 14% WINE PRODUCED INSIDE GEORGIA 14% OR LESS OVER 14% TOTAL LITERS BY CLASS $ .40 WINE TAX RATE PER LITER BY CLASS $ .67 $ .11 $ .27 GROSS TAX DUE EACH CLASS OF WINE GROSS TAX DUE (TOTAL OF ALL APPLICABLE COLUMNS) AFFIDAVIT I CERTIFY UNDER THE PENALTIES FOR FILING FALSE RETURNS, THAT I HAVE PERSONAL KNOWLEDGE AND UNDERSTANDING OF STATEMENTS MADE IN THIS RETURN AND THAT THE FIGURES PRESENTED HEREIN, INCLUDING ACCOMPANYING SCHEDULES, ARE TRUE, CORRECT, AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND ARE FILED IN ACCORDANCE WITH THE LAW. SIGNED (Officer, Partner or Owner) TITLE DATE ATTACH A LEGIBLE COPY OF ALL INVOICES TO THE BACK OF THIS RETURN American LegalNet, Inc. www.FormsWorkFlow.com