Annual Reciprocal Wine Shipment Report Form - State Of Wisconsin Page 2
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1
2INSTRUCTIONS
NAME, ADDRESS AND OWNERSHIP CHANGES
WHO MUST FILE THIS REPORT
All out-of state wineries authorized by the Wisconsin De-
You must notify the department in writing when your busi-
partment of Revenue to ship wine to individuals in this state
ness changes its name, address, ownership or Federal
Employer Identification Number (FEIN).
under the reciprocal wine agreement shall submit an an-
nual report to the Department by January 31st of the fol-
lowing year.
Ceasing Operations – Written notification is also required
when you cease operating in Wisconsin so we can inacti-
vate your permit. You are responsible for filing a report up
All in-state permittees that ship wine from this state to indi-
viduals in another state under authorization of a reciprocal
until the time you ceased operating in Wisconsin.
wine agreement shall submit an annual report to the De-
COMPLETING YOUR REPORT
partment by January 31st of the following year.
Enter your company’s name and address as they appear
SHIPMENT OF PRODUCT
on the permit issued by the department. Also, enter the
year covered by your report, your Wisconsin permit num-
A winery may ship wine into this state or out of this state
ber and your Federal Employer Identification Number
under the reciprocal wine agreement to an individual who
is of legal drinking age. The individual must acknowledge
(FEIN).
receipt of the wine shipped in writing. The shipping con-
Name
tainer must be clearly labeled to indicate that the package
may not be delivered to an underage person or to an in-
Line 1: Enter the name of the individual purchasing the
toxicated person. A signature on the delivery form of the
wine for shipment into or out of Wisconsin.
common carrier by a person of legal drinking age acknowl-
Line 2: Enter the name of the individual receiving the wine
edges delivery in writing.
(if different from the line 1 individual).
A person receiving wine under the reciprocal wine
Address
agreement may not sell it or use it for a commercial
Line 1: Enter the address of the individual purchasing the
purpose.
wine for shipment into or out of Wisconsin.
Line 2: Enter the address of the individual receiving the
DUE DATE OF REPORT
wine (if different from the line 1 individual).
Your report is due January 31st of each year. To be timely
filed, the envelope must be postmarked by a U.S. Post
Birthdate
Office on or before the due date and received by the de-
Line 1: Enter the birthdate of the individual ordering the
partment within five (5) days of the due date.
wine.
Line 2: Enter the birthdate of the individual receiving the
Late-filed reports are subject to a statutory $10 late-filing
wine (if different from the line 1 individual).
fee.
NOTE: Both individuals must be of legal drinking age.
WHERE TO FILE YOUR REPORT
Mail your report to:
Invoice – Enter the invoice number and date.
Wisconsin Department of Revenue
Type of Product – List the type of product purchased, i.e.
Mail Drop 5-107
Cabernet Sauvignon, Merlot or Chardonnay.
Post Office Box 8900
Madison, WI 53708
Total Invoice Price – List the total of all products shipped
on the invoice, less shipping and handling.
INVOICES ARE NOT REQUIRED – IT IS NOT NECES-
SARY TO SUBMIT INVOICES WITH YOUR REPORT.
Wine Liters – List the total liters shipped into or out of
THE DEPARTMENT WILL CONTACT YOU IF AN IN-
Wisconsin.
VOICE IS REQUIRED.
Calculate wine under and wine over liters according
KEEP COMPLETE AND ACCURATE RECORDS
to federal regulations. Extend liters to the nearest hun-
You must keep a complete copy of your report and all
dredth, for example, 3.25 liters.
records pertaining to your business for at least four years.
The records must be kept in a place and manner easily
SIGN AND DATE THE REPORT, AND INCLUDE A TELE-
accessible for review by department personnel.
PHONE NUMBER.
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