Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Indiana Wholesalers Excise Tax Report Form. This is a Indiana form and can be use in Department Of Revenue Statewide.
Loading PDF...
Tags: Indiana Wholesalers Excise Tax Report, 710, Indiana Statewide, Department Of Revenue
Indiana Department of Revenue
Indiana Wholesaler’s Excise Tax Report
Form 710
State Form 46926
(R2 / 3-09)
Reporting Month ________________ Year________________
Name (As Appears on Permit)
Federal I.D. Number
Mailing Address
City
State
State Wine Permit Number
Zip Code
State Liquor Permit Number
► The report is due on or before the 20th day of the month following the month being reported. ◄
GALLONS
WINE
1. Gallons per Schedule WL1 .................................................................. 1.
2. Gallons per Schedule WL2 ................................................................. 2.
3. Subtotal Lines 1 and 2 ........................................................................ 3.
Deduct:
4. Schedule WL3 .................................................................................... 4.
5. Schedule WL4 .................................................................................... 5.
6. Subtotal Lines 4 and 5 ........................................................................ 6.
7. Gallons Subject to Tax (Subtract Line 6 from Line 3) ................... 7.
TAX
8. Multiply Line 7 by Tax Rate ................................................................. 8.
($2.68 for Liquor, $ .47 for Wine)
9. Discount (Line 8 x .015) if filed timely ................................................. 9.
10. Net Amount Due (Line 8 - Line 9) ........................................................ 10.
11. Total Wine and Liquor Taxes Due ....................................................
12. Adjustments Auth. @ Dept. of Revenue (Money Only Supporting Documents must be attached .......
13. Penalty: If return is filed after due date, add penalty. Penalty is 10% of Line 11 or $5.00 whichever
is greater. .............................................................................................................................................
14. Interest: If return is filed after due date, add interest Call the Department of Revenue at
(317) 232-2240 for interest amount......................................................................................................
15. TOTAL AMOUNT DUE: (Add Line 11 + or - Line 12 + 13 and 14) ......................................................
LIQUOR
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
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 the form: Call (317) 615-2710
American LegalNet, Inc.
www.FormsWorkflow.com
