Form Et-36 - Ohio Wine And Mixed Beverage Tax Return Form - Ohio Department Of Taxation

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Excise Tax Form
ET-36 (Rev. 2/01)
Ohio Wine and Mixed Beverage Tax Return
P.O. Box 530= Columbus, OH 43216-0530
Return is due on or before the 18th day of
Reporting Period
the month following the reporting period.
For Treasurer of State
Use Only
For Month of:
, 20 ____
Account Number __________________________________________________
Name __________________________________________________________
Address ________________________________________________________
City ________________________________ State __________ Zip _________
Report in Gallons and Fractions Thereof
A
B
C
D
E
F
14% or Less
14-21%
Vermouth
Mixed Bev.
Sparkling
Cider
21%–Less
6% or Less
1. Bottled Beverage Received
Tax Not Paid (Schedule A)
2. Bottled Beverage Removed from
U.S. Customs Bonded Warehouse
3. Beverage Removed from
Bonded Wine Cellar
4. Mixed Beverage Bottled and Sold
in Ohio (A-4 Permit Holders Only)
5. Total of Lines 1, 2, 3, and 4.
6. Sales for Sacramental Purposes
by B-3 Liquor Permit Holders Only
7. Sales in Interstate Commerce
(Complete Schedule C)
8. Sales to Authorized Agencies
of the U.S. Government
9. Total Exempt Sales
(Total of Lines 6, 7, and 8)
10. Taxable Gallons
(Line 5 less Line 9)
Tax Rate
.30
.98
1.08
1.20
1.48
.24
11. Multiply Totals on Line 10
by Tax Rate
$
$
$
$
$
$
12. Tax Liability (Total Amounts Shown on Line 11, Columns A, B, C, D, E & F)
$
Gallons
13. Additional Tax ($ .02 per gallon reported on Line 10
Columns A, B, C & E – Do not include Columns D or F)
X .02
$
Gallons
14. Ohio Wine Exempt Sales
X .02
$
15. Sub-Total (Line 12 plus Line 13 less Line 14)
$
16. Discount if Applicable (3% of Amount Shown on Line 15)
$
17. Total Tax to be Paid with this Return (Line 15 less Line 16)
$
I declare under penalties of perjury that this return, including any accompanying
Check or money order must be made payable to and
schedules and statements, has been examined by me and, to the best of my
received by the Treasurer of State of Ohio, P.O. Box
knowledge and belief, is a true, correct and complete return and report.
16763, Columbus, OH 43216-6763 together with this
report on or before the 18th day of the month following
________________________________________________________________
this report period.
Date
Authorized Signature
State Use Only

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