Annual Reciprocal Wine Shipment Report Form - State Of Wisconsin

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WISCONSIN ANNUAL RECIPROCAL WINE SHIPMENT REPORT
Mail report by January 31st to:
Reporting Year
Name
Wisconsin Department of Revenue
WI Permit Number
PO Box 8900
Address
Madison, WI 53708-8900
Phone: (608) 266-6702
City
State
Zip Code
FEIN
Fax: (608) 261-7049
Name
Total
Wine
Wine
Invoice
List Type
Invoice
Liters
Liters
Line 1: Buyer
Address
Birthdate
No.
Date
of Product
Price
14% or less
over 14%
Line 2: Shipped to
I declare under penalties of law that I have examined this return and to the best of my knowledge and belief, it is true, correct and complete.
Signature
Business Phone
Date
Title
AB-135 (R. 7-04)

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