TENNESSEE DEPARTMENT OF REVENUE WHOLESALE ALCOHOLIC BEVERAGE RETURN Filing Period ALC 102 Account No. SSN OR FEIN Beginning: Due Date Ending: Returns must be postmarked by the due date to avoid the assessment of penalty and interest. Returns must be filed even if no sales were made or any tax is due. Make your check payable to the Tennessee Department of Revenue for the amount shown on Line 10 and mail to: Tennessee Department of Revenue Andrew Jackson State Office Bldg. 500 Deaderick Street Nashville, TN 37242 REMINDERS 1. 2. 3. 4. Please read instructions on reverse side before preparing this return. Transfer the amounts reported in Schedules A and B to the appropriate lines in Columns 1 -3 on front of return. Attach any printout and/or documentation as required by instructions on reverse side. Sign and date return in the signature box below. IF AN AMENDED RETURN CHECK HERE CARRY LITERS TO FOUR DECIMAL PLACES COLUMN ONE ALCOHOLIC BEVERAGES (Alcohol content > 7%) COLUMN TWO ALCOHOLIC BEVERAGES (Alcohol content >5% - 7%) COLUMN THREE WINE 1. Total liter disposition (From Sch. A,Line 5)............. 2. Exemptions in liters (From Sch. B, Line 8)............. 3. Adjusted gross sales (Subtract Line 2 from Line 1).................................................................. 4. Tax rate............................................................... 5. Tax liability (Multiply Line 3 by Line 4).................... 6. Total tax due (Add all columns in Line 5)....................................................................................................... 7. Credit (Enter outstanding credit amount from Department of Revenue notice(s))................................................ 8. Penalty (See instructions on back)................................................................................................................ 9. Interest (See instructions on back)................................................................................................................ 00 10. Total amount due (Add Line 6, 8, and 9; subtract Line 7 if applicable).............................................................. I declare this is a true, complete, and accurate return to the best of my knowledge. FOR OFFICE USE ONLY SIGN HERE SIGN HERE RV-R0005901 Signature of taxpayer Date If preparer other than taxpayer Date American LegalNet, Inc. www.FormsWorkFlow.com INTERNET (05-10 For additional information, contact the Taxpayer and Vehicle Services Division in one of our Department of Revenue Offices: Chattanooga (423) 634-6266 Suite 350 State Office Building 540 McCallie Avenue Chattanooga, TN 37402 Jackson (731) 423-5747 Suite 340 Lowell Thomas Building 225 Martin Luther King Blvd. Jackson, TN 38301 Johnson City (423) 854-5321 204 High Point Drive PO Box 2365 Johnson City, TN 37605-2365 Knoxville (865) 594-6100 Room 606 State Office Building 531 Henley Street Knoxville, TN 37901 Memphis (901) 213-1400 3150 Appling Road Bartlett, TN 38133 Nashville (615) 253-0600 3rd Floor Andrew Jackson Building 500 Deaderick Street Nashville, TN 37242 Tennessee residents can also call our statewide toll free number at 1-800-342-1003. Out-of-state callers must dial (615) 253-0600. INSTRUCTIONS General: A per liter tax is levied on the sale or gift of wine, alcoholic beverages with an alcoholic content of greater than 7% (>7%), and alcoholic beverages with an alcoholic content of greater than 5% through and including 7% (>5% - 7%), and a proportional rate per liter or container of more or less than one liter. Due Date: Taxpayer/ Tax Preparer's Signature: The return, along with the appropriate tax payment, is due to be filed on or before the 15th day of the month following the period covered. Penalty and Interest: You must sign and date your return. Paid preparers (accountants, attorneys etc.) must also sign the return. If the return is filed and or payment is made after the due date reflected on the return, compute the amount of penalty due for the number of days delinquent. Subtract Line 7 from Line 6 and compute penalty as follows: 1 - 30 days = 5%; 31 - 60 days = 10%; 61 - 90 days = 15%; 91 - 120 days = 20%; 121 days and over = 25%. The maximum penalty amount is 25%. The minimum penalty amount is $15. Calculate the interest due. Multiply the amount of tax due and reported on Line 6 less Line 7 by the number of days delinquent. Multiply that result by the current interest rate. Divide that result by 365.25. Filing: Amended Return: Make your check payable to the Tennessee Department of Revenue for the amount shown on Line 10 of the return and mail with the return to: Tennessee Department of Revenue, Andrew Jackson State Office Building, 500 Deaderick Street, Nashville, Tennessee 37242. Payment of the tax by Electronic Funds Transfer (EFT) does not relieve you of filing a timely tax return. If this is an amended return, please indicate "Filing Period" and check the appropriate box on the front of this form. SCHEDULE A Merchandise Inventory: Compute and transfer amounts on Line 5 to LIne 1 on front of return. COLUMN ONE ALCOHOLIC BEVERAGES (Alcohol content > 7%) COLUMN TWO ALCOHOLIC BEVERAGES (Alcohol content >5% - 7%) COLUMN THREE WINE 1. Number of liters on hand beginning of month .... 2. Total liters purchased (Attach printout) .................. 3. Number of liters available (Add Lines 1 & 2) ........... 4. Liters on hand at end of month ............................ 5. Total liters disposition (Subtract Line 4 from Line 3) NOTE: Printouts for purchases and for exemptions, Schedule B, Lines 1 thru 3, must be attached along with any other documentation for exemptions, Schedule B, Lines 4 thru 7. SCHEDULE B Exemptions-Liters: Compute and transfer amounts on Line 8 to Line 2 on front of return. COLUMN TWO COLUMN ONE COLUMN THREE ALCOHOLIC BEVERAGES ALCOHOLIC BEVERAGES WINE (Alcohol content >5% - 7%) (Alcohol content > 7%) 1. Sales to other wholesalers .................................. 2. Returns to Distillers, Suppliers or Exports .......... 3. Returns from retailers .......................................... 4. Damaged or deteriorated merchandise ............. 5. Sales for sacramental purposes ............................ 6. Sales to military installations ............................... 7. Accountable losses by fire or otherwise ............. 8. Total exemptions (add Lines 1 thru 7) ................ American LegalNet, Inc. www.FormsWorkFlow.com