Wine Out-Of-State Direct Shipper Monthly Tax Report
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Wine Out-Of-State Direct Shipper Monthly Tax Report Form. This is a Wyoming form and can be use in Department Of Revenue Statewide.
Loading PDF...
Tags: Wine Out-Of-State Direct Shipper Monthly Tax Report, Wyoming Statewide, Department Of Revenue
Wyoming Department of Revenue
Liquor Division
1520 East 5th Street
Cheyenne WY 82002-0110
(307) 777-7120
WINE OUT-OF-STATE DIRECT SHIPPER
MONTHLY TAX REPORT
Name of Direct Shipper
Address
For the Month of
____________________, 200_____
License #
Date Submitted
_______/_______/_______
This report along with copies of all invoices shipped into Wyoming must be filed monthly so as to arrive at the
Department of Revenue Liquor Division on or before the 10th of the following month.
Invoices Shall Be Submitted With Report
Address Shipped To
# of
Bottles
Invoice #
Volume
In Liters
Price of Wine
Per Invoice
Total Price of WINE Shipped into Wyoming (enter as “Total Report Price” below)
Attach additional sheets, if necessary.
Report the price of WINE invoiced only. DO NOT report
shipping, packaging, taxes or any other costs.
Total Report Price
$
Times (X) .12
For Official Use Only
212040
212121
710500
Total Tax Due at 12%
$
Affidavit of Authenticity: I understand that by signing this return I affirm all information shown is true and correct to
the best of my knowledge. I understand that this statement is made subject to the penalties described in W.S. 12-2204. I understand I am to retain all ordinary business records pertaining to this return for at least 3 years and allow the
Department of Revenue Liquor Division to audit such records upon reasonable request.
Owner or Officer
Make your check payable to:
“Wyoming Liquor Division”
Return this form and your total payment to:
Wyoming Liquor Division
1520 E. 5th Street
Cheyenne, WY 82002
American LegalNet, Inc.
www.FormsWorkFlow.com
