Fillable Form Ab 910 Indiana Brewers Excise Tax Report printable pdf download

Form Ab 910 Indiana Brewers Excise Tax Report

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Indiana Department of Revenue

Indiana Brewers Excise Tax Report

Form AB 910

State Form 46776

Reporting Month ________________ Year________________

(R2 / 3-09)

Name (As Appears on Permit)

Indiana Brewer’s Permit Number

Address

Telephone Number

City/State

Zip Code

Federal Identiﬁ cation Number

Mail To: Indiana Department of Revenue

P.O. Box 6114

Indianapolis, IN 46206-6114

Gallons produced and sold in Indiana .......................................................................................... 1. _________________ Gal.

Multiply Line 1 by Tax Rate of .115 ............................................................................................. 2. _________________

Discount (Line 2 X .015) if timely ﬁ led ....................................................................................... 3. _________________

If return is ﬁ led after due date, add 10% of line #2 (X.10) or $5.00, whichever is greater.

(Penalty is $5.00 if return is ﬁ led late with no tax due.) ............................................................... 4. _________________

If return is ﬁ led late, add interest .................................................................................................. 5. _________________

Amount Due ................................................................................................................................ 6. _________________

Discount (Line 3) does not apply unless the report and payment are timely ﬁ led. The report is due on or before the 20th day of

the month following the month being reported. A report must be ﬁ led even if there are no sales during the reporting period.

I hereby certify, under penalty of perjury, that the information contained herein, and on supporting documents is to the best

of my knowledge true and correct.

____________________________________

___________________________________

_________________

(Name of Business or Taxpayer)

Signature of Agent or Ofﬁ cer

Date

Questions related to this form: Call (317) 615-2710