Form Wv/wne-01 - Monthly Summary Report Of Wine Shipped
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2WV/WNE-01 (rev 12/06)
Monthly Summary Report of Wine Shipped Into the State of West Virginia
For the Period Ending:
THIS REPORT IS DUE ON OR BEFORE THE 15TH OF THE FOLLOWING MONTH
/
/
Shipping Company Name:
Check here if invoice must accompany form.
Address:
Check here if form must be filed if no activity has occurred.
City:
State:
Zip:
Other requirements that must be fulfilled (specify below).
MAIL TO:
WV STATE TAX DEPARTMENT OBR
Phone:
Fax:
Federal Tax ID# :
License # :
P.O. BOX 2666
CHARLESTON, WV 25330-2666
**** TAX RATE: .26406 CENTS PER LITER ****
Wholesaler/Distributor Sold Or Delivered To
Invoice Information
Wines (7% or less)
Wines (7 to 14%)
Wines (Over 14%)
Sparkling Wines
Tax
Computation
Business Name
Invoice #
Invoice Date
# Gallons
# Liters
# Gallons
# Liters
# Gallons
# Liters
# Gallons
# Liters
(If Applicable)
SUBTOTALS:
___________ liters x .26406= total tax due
USE BLACK OR BLUE INK ONLY---DO NOT PHOTOCOPY
Total Tax Due:
$
,
.
declare under penalty of perjury under the laws of the state of WEST VIRGINIA that the foregoing is true and correct.
*O32120601W*
I
Signed: _________________________________________________________________________________
TAX CODE 25
Authorized Signature
Date
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