en-US73A576 (06-17)en-USCommonwealth of Kentuckyen-USDEPARTMENT OF REVENUEen-USVINTNER222Sen-US WINE REPORT en-USFOR DEPARTMENT USE ONLY � � � � � � / � � / � � � / � � � Account Number � Tax � Mo. � Yr. en-USFile with the Department of Revenue on or before the 20th of the month following the month for which the report is made.en-USIf a small farm winery, this report is due on or before the 20th of the month following the quarter for which the report is made. en-USName and Address of Vintneren-USRevenue Account Numberen-USState License Numberen-USReport for Month ofen-US, 20 en-USNumber of Cases Part I227 � Wine Excise � Tax Report en-US4 Gal.en-US12 Liters � 1. � Direct sales to Kentucky retailers � and consumers (as shown on Form 73A530) �. � � 2. � Samples taken � from Kentucky inventory �. .............................. � � 3. � Other �. .............................................................. � � 4. � Total subject to excise tax � (add lines 1, 2 and 3) �. ..................................... � � 5. � Less quantities returned � by retailers and consumers � (complete schedule on reverse side) �. .............. � � 6. � Balance subject to excise tax � (line 4 minus line 5) �. ....................................... � � 7. � Tax rate per case �. ............................................ � $ � 2.00 � $ � 1.60 � $ � 1.50 � $ � 1.20 � $ � 1.59 � $ � 1.19 � $ � 1.19 � $ � 4.80 � � 8. � Excise tax applicable � (line 6 times line 7) �. ........................................ � � 9. � Miscellaneous credits and � charges �. ........................................................... � $ � $ � $ � $ � $ � $ � $ � $ � 10. � en-USTotal excise tax dueen-US (total of all items on line 8 plus or minus line 9) �. ................................................................................... � $ � en-US21en-USPart II227Wine Wholesale Sales Tax Report 11. � Gross receipts from sales of wine to Kentucky retailers and consumers (tax included) �. .................................... � $ � 12. � Receipts from sales of wine produced by small farm winery producing no more than 50,000 gallons per � calendar year �. ....................................................................................................................................................... � $ � 13. � Net receipts (line 11 minus line 12) �. .................................................................................................................... � $ � 14. � Taxable receipts (line 13 divided by 1.1025) �. ...................................................................................................... � $ � 15. � Gross tax applicable (line 14 times .1025) �. ......................................................................................................... � $ � 16. � Collection and reporting fee (line 15 times .01) �. ................................................................................................. � $ � 17. � Net tax due (line 15 minus line 16) �. .................................................................................................................... � $ � 18. � Miscellaneous credits and charges �. ...................................................................................................................... � $ � 19. � en-USTotal wholesale sales tax dueen-US (line 17 plus or minus line 18) �. .................................................................. � $ � en-US24 en-USen-USand belief, a true, correct and complete report.en-US � � � � en-US � � � Signature � Title � Date � � � en-US3.2 Gal.en-US3 Gal.en-US2.4 Gal.en-US9 Litersen-USMiniaturesen-USOtheren-US(specify)en-USen-US187 Mls.en-USIMPORTANT NOTICEen-USMake check(s) payable toen-US Kentucky State Treasurer. * � � * en-USTotal Gallons Produced Annually (must be included on December report)en-US American LegalNet, Inc. www.FormsWorkFlow.com 73A576 (06-17) � Page 2 en-USSCHEDULE OF WINE RETURNEDen-USBY KENTUCKY WHOLESALERS AND RETAILERS/CONSUMERS en-USNumber of Casesen-US4 Gal.en-US12 Litersen-US3.2 Gal.en-US3 Gal.en-US2.4 Gal.en-US9 Litersen-USMiniaturesen-USOtheren-US(specify)en-USHalf-Pinten-US187 Mls. en-USDateen-USReturneden-USName of Wholesaleren-USof Retailer/Consumeren-USGross receipts from sales at wholesale or wholesale sales shall not include the following sales: � 225 � Sales made between wholesalers or between distributors. � 225 � Sales made by a small farm winery or wholesaler of wine produced by a small farm winery, if that small farm winery produces en-USen-USKRS 131.180 imposes a penalty of 2 percent of the tax, up to a maximum of 20 percent of the tax for each 30 days or fraction thereof that en-USen-USen-USen-USAdditional information may be obtained by contacting the Excise Tax Section, Department of Revenue, Station 62, P.O. Box 1303, Frankfort, en-USKentucky 40602-1303, or by calling (502) 564-6823. American LegalNet, Inc. www.FormsWorkFlow.com