Form Wl-5 - Report Of Wine Or Liquor Placed In Bond
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1
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3Indiana Department of Revenue
Report of Wine or Liquor placed in Bond
WL-5
(Formerly Schedule C-3)
State Form #46972
Revised 1/95
Reporting Month ________________ Year________________
Name (Wholesaler As appears on Permit)
Federal I.D. Number
Address
City
State
Zip
State Wine Permit Number
State Liquor Permit Number
To be accompanied by Federal Report Form 7501 Entry Summary.
Mail To:
Indiana Department of Revenue
P.O. Box 901
Indianapolis, IN 46206
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