Wv/frm-01 West Virginia Licensed Farm Wineries Monthly Production Report Form printable pdf download

Wv/frm-01 West Virginia Licensed Farm Wineries Monthly Production Report Form

EST

IRGINIA

TATE

EPARTMENT

License #

Internal Auditing Division - OBR Unit

FEIN #

PO Box 2666

Charleston WV 25330-2666

(304) 558-8622

WEST VIRGINIA LICENSED FARM WINERIES

MONTHLY PRODUCTION REPORT

West Virginia Legislative Regulations, Title 175, Series 3

-4.11 "Every licensed farm winery shall report its total gallonage of wine produced or blended for the twelve (12) month

period ending June 30 of each year or partial year. Such report shall be submitted by letter report within thirty (30) days after

the end of such fiscal year."

For your convenience, the information may be reported monthly

Information contained on this form should

show the same quantities as Aft Form. 702, Part 1, Line 2.

USE BLACK OR BLUE INK ONLY--DO NOT PHOTOCOPY

Report for the Month of:

WINE PRODUCED BY FERMENTATION -

____________________ Gallons

For the Period _____________________ through ____________________.

Please mail completed return to:

West Virginia State Tax Department

Internal Auditing Division - OBR Unit

PO Box 2666

Charleston WV 25330-2666

I hereby certify this report to be true and correct to the best of my knowledge.

Signature _________________________________

Date Filed ____________________________________

TAX CODE 25

*O35120601W*

WV/FRM-01 (rev 12-06)

Wv/frm-01 West Virginia Licensed Farm Wineries Monthly Production Report Form