Form Wv/ber-01 - Report For Distributors And/or Wholesalers Of Nonintoxicating Beer

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WV/BER-01 (rev 12-06)
FILE THIS REPORT ON OR
WEST VIRGINIA DEPARTMENT OF TAX AND REVENUE
BEFORE THE 15TH DAY OF
INTERNAL AUDITING DIVISION
THE MONTH FOLLOWING
OBR UNIT
MONTH FOR WHICH THE
#
FEIN
P.O. BOX 2666
REPORT IS MADE.
CHARLESTON, WV 25330-2666
(304) 558-8622
REPORT FOR DISTRIBUTORS AND / OR WHOLESALERS OF NONINTOXICATING BEER
For the Period Ending:
NAME
PHONE
ADDRESS
CITY/STATE
ZIP
REPORT MUST BE STATED IN BARRELS, GALLONS OR OUNCES.
INDICATE METHOD______________________
BREWER PURCHASES
INVOICE DATE
INVOICE #
BREWER
QUANTITY RECEIVED
TAX CODE 27
USE BLACK OR BLUE INK ONLY
DO NOT PHOTOCOPY
*O37120601W*

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