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Wine Authorized Representative Certificate Of Approval Holder Summary Tax Report Form. This is a Washington form and can be use in Liquor Control Board Statewide.
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WINE AUTHORIZED REPRESENTATIVE CERTIFICATE OF APPROVAL HOLDER SUMMARY TAX REPORT FORM LIQ-318 3000 PACIFIC AVE SE PO BOX 43085 OLYMPIA WA 98504-3085 E-mail: firstname.lastname@example.org Fax: (360) 704-4909 (Revised 01/10) Licensee Number REPORTING MONTH Licensee Name Location Address YEAR City, State & Zip Check if applicable: NO DOMESTIC SHIPMENTS If Correction Report (check box) NO FOREIGN SHIPMENTS PART 1: NON-TAXABLE (List by Washington Distributor and/or Importer) Current licensee lists are available at WSLCB website: http://www.liq.wa.gov/publications/WineandBeer.asp (1) WSLCB LICENSE NO. (2) SOLD TO DISTRIBUTOR OR IMPORTERS NAME (3) REPORT IN LITERS (5) CIDER LITERS (6) 14% AND UNDER LITERS (7) OVER 14% LITERS SAMPLE CIDER SAMPLE 14% & SAMPLE OVER 14% IN LITERS CITY (4) (F) Foreign (D) Domestic IN LITERS IN LITERS Total Liters from all other pages (If multiple pages used) (8) TOTAL LITERS THIS PAGE PLUS TOTAL FROM Line (8) (9) PART 2: TAXABLE (SAMPLES SHIPPED TO RETAILERS AND DONATIONS TO NON-PROFIT) (10) (11) (12) Certified True and Correct Under Penalty of Perjury Box (10) X $0.0814 = (13) Signature of Person Completing Form: (13) Box (11) X $0.2292 = (14) Box (12) X $0.4536 = (15) (14) (15) Printed Name: Taxes Due Current Month (16) Telephone Number: PENALTIES for late reporting are 2% per month of amount due on line 16 (17) E-mail Address: Balance or Refund Due (if any) (18) Date: TOTAL DUE (19) $ WSCLB USE ONLY WSLCB USE ONLY Payee Number Amount Received Refund Amount Postmark Date LIQ-318 Revised (01/10) American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Completing LIQ-318 WINE AUTHORIZED REPRESENTATIVE CERTIFICATE OF APPROVAL HOLDERS SUMMARY TAX REPORT This report must be completed by all Wine Authorized Representative Certificate of Approval Holders each month and postmarked on or before the 20th of the following month. When the 20th falls on a Saturday, Sunday, or a legal holiday, the filing must be postmarked by the U.S.Postal Service no later than the next postal business day. A report must be filed EVERY MONTH, including months when there is no activity. Report all shipments in the month regardless of invoice date. DO NOT REPORT SALES DELIVERED TO: WSLCB, Military Installations, Commercial Carriers, or Ships Chandlers. Correction report (check box): Include changes only (additions or subtractions) that need to be made to the original report. Licensee Number: Licensee Name: Location Address: City, State, Zip: Enter your Washington State Liquor Control Board (WSLCB) 6 digit licensee number. Trade Name per license number entered. Location address per license number entered. City, State and Zip Code per license number entered. MONTH: YEAR: Enter report month (month when the beer was shipped into WA). Enter report year. NOTE: DO NOT DUPLICATE REPORTING OF THE REPRESENTED PRODUCT ON ANY OTHER FORMS; example Form LIQ-778 NO DIRECT SHIPMENTS TO EITHER A WASHINGTON CONSUMER OR RETAILER ARE ALLOWED WITH THIS PRIVILEGE Please complete the numbered fields as follows: (round to two decimal places) If you are licensed for domestic and/or foreign shipments and you have no shipments for the month, make sure you check the appropriate box for no shipments. Part 1 (1) (2) (3) (4) (5) (6) (7) (8) (9) NON-TAXABLE SHIPMENTS Enter the 6-digit WSLCB license number of receiving distributor or importer in Washington State. Licensee Lists and Forms may be found on the website at: http://www.liq.wa.gov/publications/WineandBeer.asp Enter the trade name of receiving distributor or importer in Washington State. Enter the city location of the distributor / importer. For product shipped to the distributor or importer enter: • D or Domestic for wine produced in the United States • F or Foreign for product produced outside of the country • Use ONE line per distributor or importer for Domestic product shipped • Use ONE line per distributor or importer for foreign product shipped Enter the total liters of cider shipped. Enter the total liters of 14% and under shipped. Enter total liters of wine over 14% shipped. Enter total liters from all other pages (If multiple pages used). Enter total liters from this page plus total from line 8. Samples shipped to Washington Wine Distributors or Wine Importers for their use include in PART 1. Part 2 (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) TAXABLE SHIPMENTS Part 2 report wine samples that are shipped to Washington retailers, donations to non-profit organizations 501(c)(3) or (6), and your licensed agent. Do not report samples provided to your appointed distributor or importer in this section. Enter the total liters of cider samples shipped into the state for the month. Enter the total liters of wine 14% and under samples shipped into the state for the month. Enter the total liters of wine over 14% samples shipped into the state for the month. Calculate line 10 multiplied by $0.0814 Calculate line 11 multiplied by $0.2292 Calculate line 12 multiplied by $0.4536 Enter the total of lines 13, 14, and 15. Enter the amount of penalties if reporting late. (Reports are due the 20th of the following month and penalties accumulate at 2% PER month of the total due on line 16. Enter the amount of an exisiting credit as a negative number. Indicate a balance due as a positive number. Enter the total due from entries in box 16, 17, and 18. Certified True and Correct Under Penalty of Perjury Signature of person completing the form. Entered printed name of person who completed the form. Enter the date that form is completed. Enter the telephone number of person who completed the form. Enter the e-mail address of person who completed the form. LIQ-318 (Revised 01/10) American LegalNet, Inc. www.FormsWorkFlow.com