Form Wv/sdr-2015 - Monthly Soft Drink Report
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1
2WV/SDR-2015
REV 01/07
THIS FORM MUST BE COMPLETED
AND RETURNED ON OR BEFORE
WEST VIRGINIA STATE TAX DEPARTMENT
TH
THE 15
DAY OF THE MONTH
FOLLOWING THE MONTH FOR
PO BOX 2666
WHICH THE REPORT IS MADE
CHARLESTON WV 25330-2666
(304) 558-8617
MONTHLY SOFT DRINK REPORT
West Virginia Identification Number, Name, and Address
REPORT PERIOD
CHECK TYPE OF BUSINESS
___ Wholesaler
1
___ MFG (Bottler)
3
___ Retailer
4
___ MFG &
5
Wholesaler
BONDED? YES ___
NO___
A
B
C
D
Tax Computation
Syrups
Powders
Prepared Drinks
Total (A + B + C = D)
$
1. GROSS TAX DUE
$
2. LESS EX PORTS TAX NOT PAID
$
3. BALANCE GROSS TAX DUE
(Line 1 Less Line 2)
$
4. CREDITS
XXXXXXXX
XXXXXXXXXX
XXXXXXXXXX
(Line F - Prepayment Of Stamps And/Or Crowns)
$
5. ADJUSTED TAX DUE
XXXXXXXX
XXXXXXXXXX
XXXXXXXXXX
(Line 3 Less Line 4 Equals Line 5)
$
6. LESS DISCOUNT
XXXXXXXX
XXXXXXXXXX
XXXXXXXXXX
(Line 3, Col. C Times 12 ½ % ) BONDED ACCOUNTS
$
7. INTEREST
XXXXXXXX
XXXXXXXXXX
XXXXXXXXXX
$
8. ADDITIONS TO TAX
XXXXXXXX
XXXXXXXXXX
XXXXXXXXXX
$
9. NET TAX DUE
XXXXXXXX
XXXXXXXXXX
XXXXXXXXXX
(Line 5 Less 6 Plus 7 And 8 Equals 9)
$
10. TAX PAID OUT-OF-STATE SALES (Exports)
XXXXXXXX
XXXXXXXXXX
XXXXXXXXXX
$
11. BALANCE TAX DUE (Line 9 Less Line 10)
XXXXXXXX
XXXXXXXXXX
XXXXXXXXXX
$
12. REQUEST FOR REFUND (If Line 10 is Greater Than Line 9)
XXXXXXXX
XXXXXXXXXX
XXXXXXXXXX
ACCOUNTABILITY OF TAXABLE CROWNS, CAPS, CONTAINERS OR STAMPS
(To be designated as a single unit and do not include crowns on floor stock)
ENTER DENOMINATION
->
ST
A. ON HAND 1
OF MONTH
B. PURCHASES/RECEIPTS
(Enter Suppliers/Stamp Receipts Below)
Enter grand total
of dollar value of all
C. TOTAL AVAILABLE
(Add Lines A & B)
denominations
(by adding from left to right)
D. ON HAND END OF THE MONTH
Transfer total to
E. NUMBER OF INDICIA AFFIXED
Line 4
F. DOLLAR VALUE
$
$
$
$
$
$
$
PURCHASES/RECEIPTS REPORTED ON LINE B
SUPPLIERS/MANUFACTURERS
STAMP RECEIPTS
G. MFG/SUPPLIER: (Crowns, Lids & cartons)
CERT. NO.
AMOUNT
H. STAMPS: ( Enter date stamps were received)
_______________________________________
__________ _________
_______ _______ _______ _______ _______
_______________________________________
__________ _________
_______ _______ _______ _______ _______
_______________________________________
__________ _________
_______ _______ _______ _______ _______
_______________________________________
__________ _________
I. I certify this report to be true and correct to the best of my knowledge.
DO NOT USE THIS SPACE
*O22010701A*
Signature
___________________________________
___________________________
Title
Date
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