Idaho Direct Shipper Report Licensee & DBA Name: Physical Address: Qty Ship Date Address - Shipped To Tax 10/1/2016 4544 S. Pinto, Boise, ID 83709 1 19.80 10/15/2016 3367 S. Grand Ave, Pullman WA 0.75 1.85 Invoice No. Address - Buyer Kari Cussins Sierra Crisp Samp-01 Consumer Purchase Date Line 1 - Buyer Wattle Creek Winery Brand - Product Description Alc % Vol per bottle Price of Wine Line 2 - Shipped To Invoice Total 24.15 21.65 Contact Name: Email: Phone # : Fax #: Reporting Period: ABC License #: Idaho Tax #: Idaho State Police - Alcohol Beverage Control, 700 S Stratford Dr, Ste 115, Meridian, ID 83642 ~~ Phone #: 208-884-7060~~Email: abc@isp.idaho.gov American LegalNet, Inc. www.FormsWorkFlow.com