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Cider Wholesalers Excise Tax Report Form. This is a Indiana form and can be use in Department Of Revenue Statewide.
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Tags: Cider Wholesalers Excise Tax Report, 610, Indiana Statewide, Department Of Revenue
Indiana Department of Revenue
Cider Wholesaler’s Excise Tax Report
Form 610
Reporting Month ________________ Year________________
State Form 48913
(R2 / 3-09)
Name (As Appears on Permit)
Federal I.D. Number
Mailing Address
City
State
Zip Code
State Beer Permit Number
State Wine 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 C-1 (See Other Side).....................................................
1
2. Deduct Total Gallons of Returns to Manufacturer or Destroyed Product (Attach Documentation)
2
3. Deduct Total Gallons of Sales to U.S. Government Military Facilities (Attach Documentation)
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 are 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
Questions related to this form: Call (317) 615-2710
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Purchases of Hard Cider
Schedule C-1
No.
Manufacturer
Invoice Number
Date
Received
Cider Gallons
Per Invoice
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Total Alcoholic Cider Gallons Received (Carry This Total Over to Form 610, Line1)
Use one Invoice Per Line
Questions related to this form: Call (317) 615-2710
American LegalNet, Inc.
www.FormsWorkflow.com
