Form Reg-15 - Alcoholic Beverages Application-Small Winery Certificate
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1FORM REG-15
STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
Alcoholic Beverages Tax
PO Box 2937
Hartford CT 06104-2937
Application For
Small Winery Certificate
Rev. 04/01
(Request for Reduced Alcoholic Beverages Tax Rate on Certain Sales
by Licensed Distributors of Wine Produced by Persons Issued a Small Winery Certificate)
Conn. Gen. Stat. §12-435(g)
Please complete this application and return it to the Department at the address shown above.
Federal Employer Identification Number
<
Please
correct
name and
Social Security Number
<
address
if shown
incorrectly
Type of Organization:
H
H
Corporation
S Corporation
Owner’s Name, All Partners’ Names or Corporate Name
Telephone Number
H
Sole proprietorship
(
)
H
Partnership
H
Trade / Registered Name (if Different From Above)
Limited liability company
H
ther
O
Physical Location of This Business (PO Box is not acceptable)
Business Mail Address
State of Incorporation
Are you licensed with the Connecticut Department of Consumer Protection,
Division of Liquor Control, to distribute alcoholic beverages in Connecticut?
H
H
No
Yes
Permit No. ___________________
Purpose: Form REG-15 is an application for a Small Winery Certificate. Any winery that produced not more than 55,000 wine
gallons of wine during the preceding calendar year can apply for a Small Winery Certificate. If the Department of Revenue Services
grants your application, we will issue you a Form OR-267, Small Winery Certificate .
A licensed distributor of alcoholic beverages is subject to the Connecticut alcoholic beverages tax at the rate of 15¢ per wine gallon
(rather than the regular rate of 60¢ per wine gallon) if:
•
The licensed distributor is selling still wine that contains not more than 21% of absolute alcohol by volume; and
•
The still wine is produced by a winery with a Small Winery Certificate.
Still wine contains not more than 0.392 of a gram of carbon dioxide per hundred milliliters of wine. (Alcoholic cider is a still wine if it
contains not more than 0.392 of a gram of carbon dioxide per hundred milliliters of wine.)
Form REG-15 expires annually on June 30 and is renewable only if you file another Form REG-15.
If you have any questions, call the Public Services Taxes Unit at 860-541-3225, Monday through Friday, 8:00 a.m. to 5:00 p.m.
Declaration: I declare, under the penalty of false statement, that I have examined this application, Form REG-15, and to the best of
my knowledge and belief it is true, complete, and correct. The applicant named above produced not more than 55,000 wine gallons
of wine during 2000. (The penalty for false statement is imprisonment not to exceed one year or a fine not to exceed two thousand
dollars, or both.)
Name of Winery
:
By
__________________________________________________________
______________________________________
Name of Owner or Authorized Agent (Print or Type)
Title (Print or Type)
__________________________________________________________
______________________________________
Signature of Owner or Authorized Agent
Date
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