Form Alc-80 - Application For Refund Of Taxes On Wine And Mixed Beverages Paid In Excess Of Legal Requirements Form - Ohio Department Of Taxation

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Excise Tax Form
ALC-80 (Rev. 3/01)
P.O. Box 530= Columbus, OH 43216-0530
Application for Refund of Taxes
on Wine and Mixed Beverages Paid in Excess of Legal Requirements
Reporting Period
Account No.
For period of: _______________ , 20 ____ to ______________, 20 ____ , inclusive.
File No.
1. Name __________________________________________________________
2. Address ________________________________________________________
State File No.
City ________________________________ State __________ Zip _________
3.
If records are located at an address other than line 2, show on line 3.
4. Federal Employer Identification Number or, if none
Employer Identification Account No.
Social Security No.
assigned for reporting Federal Taxes, please enter
your Social Security Number.
5.
Wine & Mixed
Mixed Bev.
Total
Beverages
14% or Less
14-21%
Vermouth
21%-less
Sparkling
Cider
Claimed
Amount claimed
$
$
$
$
$
$
$
Less discount, if applicable
$
Total Refund
$
c
6. Reason for Claim
Exempt Sales (Complete Schedule A)
c
Unsaleable Product (Do not destroy until you have received approval from this department.)
c
Other – please explain ____________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
I declare under penalties of perjury that this return or claim (including any accom-
For Department Use Only
panying schedules and statements) has been examined by me and, to the best of
my knowledge and belief, is a true, correct and complete return and report.
Voucher No. _______________________
Claimant ________________________________________________________
GRF _____________________________
Title
__________________________________________________________
___________________
Ohio Grape Industries
.
Date ___________________________________________________________
State fully and completely reasons for above claim and attach any necessary credit memos, invoices, or other supporting evidence.
Instructions
The absence of complete records in the support of above claim will consti-
sued the distributors which clearly indicate the credit allowed the distribu-
tute a justifiable ground for disallowance of the claim.
tor included the Ohio Excise Tax.
This claim for reimbursement must be filed in accordance with the provi-
Claims filed by the distributors must be supported by credit memoranda
sions relative thereto as set forth in sections 4307.05 and 4307.07 of the
received from the suppliers which clearly indicate the credit allowed the
Revised Code. An application shall be filed with the tax commissioner on
distributor did not include the Ohio Excise Tax.
the form prescribed by him for such purposes, within ninety days from the
date it is ascertained that the payment was erroneous, or from the date
Each claimant must assign a claim file number in numerical sequence
that wine and mixed beverages on which taxes have been paid have been
starting with No. 1 in the space provided above. In this way, all claimants
sold in interstate or foreign commerce or have become unsaleable; pro-
submitting refund applications will have a claim file number sequence for
vided that in any event the application for refund of tax erroneously paid
reference purposes.
must be filed with the commissioner within three years from the date of
such erroneous payment.
Send the original and one copy to the Department of Taxation, Attn: Excise
Tax & Assessment Section, P.O. Box 530, Columbus, OH 43216-0530.
Claims filed by the suppliers must be supported by credit memoranda is-
One copy is to be retained by the claimant.

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