Form Alc-82 - Application For Refund Of Cuyahoga County Taxes On Wine And Mixed Beverages, Beer Or Malt Beverages Paid In Excess Of Legal Requirements - State Of Ohio
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1Excise Tax Form
ALC-82 (Rev. 3/01)
P.O. Box 530= Columbus, OH 43216-0530
Application for Refund of Cuyahoga County Taxes on Wine and
Mixed Beverages, Beer or Malt Beverages Paid in Excess of Legal Requirements
Reporting Period
For period of: _______________ , 20____ to ______________, 20 ____ , inclusive.
Account No.
1. Name __________________________________________________________
Print name of Permit Holder as shown on permittee’s license
File No.
2. Address ________________________________________________________
City ________________________________ State __________ Zip _________
State File No.
3. ________________________________________________________________
If records are located at an address other than line 2, show on line 3.
4. Federal Employer Identification Number or, if none
Employer Identification No.
Social Security No.
assigned for reporting Federal Taxes, please enter
your Social Security Number.
c
5. Reason for Claim.
Unsaleable Product (Do not destroy until you have received approval from this department.)
c
Other – please explain ___________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
6.
Amount of Beer and/or Malt
Beverage Tax requested:
_____________ X .16 = $ _______________
7.
Amount of Wine and Mixed
Beverage Tax requested:
_____________ X .32 = $ _______________
8.
Less Discount, if applicable
(line 6 or 7 X .025)
_______________
9.
Total Amount Requested
$ ________________
I declare under penalties of perjury that this report, including any accompanying
schedules and statements, has been examined by me and, to the best of my knowl-
For Department Use Only
edge and belief, is a true, correct and complete return and report.
Claimant _____________________________________________
Voucher No. ________________
Title _________________________________________________
Date ________________________________________________
Instructions
A separate refund claim must be submitted for beer or malt
can only be considered if filed within three years of the date of
beverage tax & wine and mixed beverage tax. All refund applica-
overpayment.
tions must be filed with the Tax Commissioner on the proper
forms. Complete records must be supplied supporting the
All claims must be numbered in sequence starting with No. 1.
information, otherwise the claim may be denied. Claims filed by
Enter the number in the file number space in the upper right
distributors must be supported by credit memoranda issued to
corner of this form.
customers indicating the product was returned and that the
county tax was paid.
Send the original copy to the Department of Taxation, Attn:
Excise Tax and Assessment Unit, P.O. Box 530, Columbus, OH
All applications for refund must be filed within 90 days from the
43216-0530. Retain the duplicate copy for your records.
date it is ascertained a refund is due. In any event, applications
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