Form Wv/dis-01 - Distributor'S Summary Of Wine Purchases, Sales & Inventory printable pdf download

Form Wv/dis-01 - Distributor'S Summary Of Wine Purchases, Sales & Inventory

EST

IRGINIA

TATE

EPARTMENT

Internal Auditing Division - OBR

PO Box 2666

Charleston WV 25330-2666

(304) 558-8622

License #

FEIN #

DISTRIBUTOR'S SUMMARY OF WINE PURCHASES, SALES & INVENTORY

*O33120601W*

For the Period Ending:

Inventory Beginning of Month

Supplier Purchases Received During Month (SCH A)

Transfers In (SCH B)

Pickups

Total ( Item 1 through 4)

6-A

Breakage, Leakage, Spoilage and Shortages

6-B

Samples

Transfers Out (SCH C)

All Other Transfers Out

Total Liters Sold to Retailers & Clubs During Month

10.

Total Depletions of Inventory (Items 6 through 9)

11.

Inventory at End of Month (Item 5 less Item 10)

USE BLACK OR BLUE INK ONLY---DO NOT PHOTOCOPY

I SWEAR (OR AFFIRM) THAT THIS REPORT HAS BEEN EXAMINED BY ME, AND, TO THE BEST OF MY KNOWLEDGE AND BELIEF, IS A TRUE

AND COMPLETE REPORT MADE IN GOOD FAITH FOR THE PERIOD AS STATED, PURSUANT TO ARTICLE 8, CHAPTER 60 OF THE WEST

VIRGINIA CODE AND REGULATIONS OF THE WEST VIRGINIA ABCA.

SIGNED

TAX CODE 25

Form WV/DIS-01 (rev 12-06)

Form Wv/dis-01 - Distributor'S Summary Of Wine Purchases, Sales & Inventory