Form Abc-1013 - Kansas Farm Winery Monthly Gallonage Tax Return And Sales Report Page 3
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4Kansas Department of Revenue
Alcoholic Beverage Control Division
915 S.W. Harrison Street, Room 214
Topeka, KS 66625-3512
Phone: 785-296-7015 Fax: 785-296-7185
KANSAS FARM WINERY MONTHLY GALLONAGE TAX RETURN AND SALES REPORT
MONTH:____________________
FEIN: ___ ___ - ___ ___ ___ ___ ___ ___ ___
YEAR: ____________________
LICENSE: 30-___ ___ ___ - ___ ___ ___ ___ - ___ ___
FARM WINERY NAME:__________________________________________________________
ADDRESS: ___________________________________________________________________
CITY/STATE: ___________________________________________ ZIP CODE: ____________
CONTACT PERSON: ___________________________________________________________
E-MAIL ADDRESS:_____________________________________________________________
No wine was bottled this report period.
Domestic wine was bottled solely and exclusively for sacramental purposes this report period.
Domestic Fortified Wine ________ gallons bottled.
Domestic Table Wine
________ gallons bottled.
Gallonage tax credit carried forward. Amount: $______________
PRODUCT TYPE:
CODE:
GALLONS
TAX RATE:
TAX AMOUNT:
TAX DUE:
BOTTLED:
Domestic
01
X
+ $
Fortified Wine
$0.75 / Gallon
=
14.1% to 20% ABV
$
(GFWF)
02
X
-
PRODUCT TYPE:
CODE:
GALLONS
TAX RATE:
TAX AMOUNT:
TAX DUE:
BOTTLED:
Domestic
01
X
$
+
Table Wine
$0.30 / Gallon
=
14.% ABV or less
$
02
X
-
(GFWL)
$
GALLONAGE TAX DUE
CREDIT FROM PREVIOUS REPORT PERIOD -
$
TOTAL GALLONAGE TAX DUE =
$
I have paid my gallonage tax using the EFT option.
CODES:
01 = Total Gallons of Wine Bottled
02 = Shipments to Out-of-State Wholesalers and/or Non-Beverage User Permittees
I declare under penalties of perjury that to the best of my knowledge and belief this is a true, correct and complete return. In addition, I am
exempt from gallonage tax imposed on domestic wine I have manufactured because it was shipped out-of-state for sale and consumption
outside of Kansas.
SIGNATURE _______________________________________ TITLE __________________________________DATE_____________
Indicate whether individual owner, member of firm, or title if officer of corporation.
ABC-1013 (Rev. 7.1.11)
Page 3 of 4
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