Form Wld-94 - Winery'S Monthly Report Of Excise Tax
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1WLD-94 (6/97)
Mail this form along with payment to:
WINERY’S
State of Wyoming
(Regulations Require report
MONTHLY REPORT OF EXCISE
WYOMING LIQUOR DIVISION
and payment due no later
Cheyenne, Wyoming 82002-0110
TAX
than
15th
of
month
following production)
Report of Wine products produced During the month of:
Winery:
Address:
City, State, Zip:
Phone Number:
MILLILITERS
1.
Wine product(s) produced during month indicated:
2.
Other (explain):
3.
Total Milliliters:
CREDITS
4.
Spoilage:
5.
Sales to Wyoming Liquor Division
6.
OUT OF STATE sales (copy of invoice[s] required):
7.
Other (explain):
8.
Total Credits:
Total Milliliters (Line 3 minus Line 8)
Divide by 100 Milliliters
/
100
SUBTOTAL
Tax per 100 Milliliters
X
.0075
TOTAL
+/- Last month Adjustment.
TOTAL TAX DUE
I do solemnly swear that the foregoing is a true and correct statement of all wine products manufactured in the
.
state during the month for which this report is rendered, to the best of my knowledge and belief
Date Signed:
Printed Name:
Signature:
White copy - Mail to Wyoming Liquor Division
Yellow copy - Retain for your records.
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