Form 810 - Beer Wholesaler'S Excise Tax Report - In Department Of Revenue
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Indiana Department of Revenue
Beer Wholesaler’s Excise Tax Report
Form 810
Reporting Month ________________ Year________________
(Formerly Schedule D)
State Form 46998
(R/ 7-02)
Name (As Appears on Permit)
Federal I.D. Number
Mailing Address
City
State
Zip Code
State Beer Permit Number
The report is due on or before the 20th day of the month following the month being reported.
GALLONS
1. Total Gallons Received per Schedule B-1 ..........................................................................
1
2. Deduct total Gallons per Schedule B-2 ..............................................................................
2
3. Deduct total Gallons per Schedule B-3 ..............................................................................
3
4. Total Deductions (Line 2 + Line 3) ...................................................................................
4
5. Gallons Subject to Tax (Line 1 minus Line 4)...................................................................
5
TAX
6. Multiply Line 5 by Tax Rate of .115 ..................................................................................
6
7. Discount (Line 6 x .015) if timely filed .............................................................................
7
8. Amount Due (Line 6 Minus Line 7) ..................................................................................
8
9. Adjustments Auth. @ Department of Revenue (Money Only) ..........................................
9
10. If return is filed after due date, Add 10% of Line 8 (x.10) or $5.00 whichever is greater.
(Penalty is $5.00 if return is filed late without tax due) .....................................................
10
11. If return is filed late add interest .......................................................................................
11
12. Total Amount Due (Line 8 + or - Line 9 + Line 10 + Line 11) Enclose your payment
for this amount .................................................................................................................
12
Discount (Line 7) does not apply unless the report and payment is timely filed.
I hereby certify, under penalty of perjury, that the information contained herein, and on supporting documents is to the best
of my knowledge true and correct.
Signature of Agent or Officer
Title
Date
Telephone Number
Mail To: Indiana Department of Revenue, P.O. Box 6114, Indianapolis, IN 46206-6114
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