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Beer Wholesalers Excise Tax Report Form. This is a Indiana form and can be use in Department Of Revenue Statewide.
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Tags: Beer Wholesalers Excise Tax Report, 810, Indiana Statewide, Department Of Revenue
Indiana Department of Revenue
Beer Wholesaler’s Excise Tax Report
Form 810
(Formerly Schedule D)
State Form 46998
(R2 / 3-09)
Reporting Month ________________ Year________________
Name (As Appears on Permit)
Federal I.D. Number
Mailing Address
City
State
Zip Code
State Beer Permit Number
► The
report is due on or before the 20th day of the month following the month being reported. ◄
Gallons
1. Total Gallons Received per Schedule B-1..............................................................................
1
2. Deduct total Gallons per Schedule B-2..................................................................................
2
3. Deduct total Gallons per Schedule B-3..................................................................................
3
4. Total Deductions (Line 2 + Line 3)........................................................................................
4
5. Gallons Subject to Tax (Line 1 minus Line 4) . ...................................................................
5
Tax
.
6. Multiply Line 5 by Tax Rate of .115......................................................................................
6
7. Discount (Line 6 x .015) if timely filed..................................................................................
7
8. Amount Due (Line 6 Minus Line 7).......................................................................................
8
9. Adjustments Auth. @ Department of Revenue (Money Only).............................................
9
10. If return is filed after due date, Add 10% of Line 8 (x.10) or $5.00 whichever is greater.
(Penalty is $5.00 if return is filed late without tax due)......................................................... 10
.
11. If return is filed late add interest............................................................................................. 11
12. Total Amount Due (Line 8 + or - Line 9 + Line 10 + Line 11) Enclose your payment
for this amount........................................................................................................................ 12
Discount (Line 7) does not apply unless the report and payment is timely filed.
I hereby certify, under penalty of perjury, that the information contained herein, and on supporting documents is to the best
of my knowledge true and correct.
__________________________________________________________________________________________________________
Signature of Agent or Officer
Title
__________________________________________________________________________________________________________
Date
Telephone Number
Mail To: Indiana Department of Revenue, P.O. Box 6114, Indianapolis, IN 46206-6114
Questons related to this form: Call (317) 615-2710
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