VERMONT VINOUS BEVERAGE TAX RETURN REPORTING PERIOD - Return with payment is due on or before the 10th of each month. IN-STATE WINERIES & DISTRIBUTORS OUT-OF-STATE WINERIES ONLY _______________, 20_____ Month Jan. - June, 20_____ July - Dec., 20_____ Vermont Department of Taxes PO Box 547 Montpelier, VT 05601-0547 Distributor Name or Winery Telephone Number Address Federal ID Number City, State, ZIP Code E-mail address (A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) Number of Bottles 18 L 12 L 4L 3L 1.5 L 1.0 L 750 ML 375 ML 187 ML 608.4 oz. VINOUS BEVERAGES 405.6 oz. 135.2 oz. 101.4 oz. 50.7 oz. 33.8 oz. 24.5 oz. 12.7 oz. 6.3 oz. $2.61 $1.74 $0.58 $0.44 $0.22 $0.15 $0.11 $0.05 $0.03 1. Amount on hand first of the month 2. Purchased or fermented (from Form VB-2, Line 3) 3. Total Available (Add Lines 1 and 2) 4. Amount on hand end of the month 5. Total outage (Subtract Line 4 from Line 3) 6. Total Credits (Attach list of credit memos) 7. Taxable amount (Subtract Line 6 from Line 5) 8. Tax rate per bottle ($0.55 per gallon) 9. TAX (Multiply Line 7 by Line 8) 10. TAX DUE on Vinous Beverages (Add Line 9, Columns A-K). Make check payable to VT DEPARTMENT OF TAXES . . . . . . . . . . . . . . . . . . 10. Out-of-State wineries holding a license from the VT Department of Liquor Control: Do not complete Lines 1-6. Enter your direct to VT consumer shipments on Line 7 and calculate the tax due. Returns must be completed semi-annually as long as you hold a license issued by VT Department of Liquor Control. I hereby certify that this return has been examined by me, and to the best of my knowledge, is a true and complete return for the month stated, pursuant to 7 V.S.A. §421. Signature Title VB Date Rev. 10/07 Form VB-1 American LegalNet, Inc. www.FormsWorkFlow.com