Form Reg-15 - Alcoholic Beverages Tax Application For Small Winery Certificate
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1Department of Revenue Services
REG-15
State of Connecticut
Alcoholic Beverages Tax
PO Box 2937
Application For
Hartford CT 06104-2937
Small Winery Certifi cate
Rev. 06/11
Request for Reduced Alcoholic Beverages Tax Rate on Certain Sales
by Licensed Distributors of Wine Produced by Persons Issued a Small Winery Certifi cate
Conn. Gen. Stat. §12-435(g)
Please complete this application and return it to the Department of Revenue Services (DRS) at the address shown above.
Federal Employer Identifi cation Number
Please
correct
name and
Connecticut Tax Registration Number
address
if
incorrect.
Type of Organization:
Corporation
S Corporation
Name(s) of owner(s), partner(s), or corporate name
Business telephone number
of owner or partner
Sole proprietorship
Partnership
(
)
Limited liability company
Trade/registered name (if different from above)
Other
Physical location of this business (PO box is not acceptable.)
Business mail address (if different from physical location of business)
State of incorporation
Are you licensed with the Connecticut Department of Consumer Protection,
Division of Liquor Control, to distribute alcoholic beverages in Connecticut?
No
Yes
If yes, list your Permit No._________________
Purpose: Form REG-15 is an application for a small winery certifi cate. Any winery that produced not more than 55,000 wine gallons
of wine during the preceding calendar year can apply for a small winery certifi cate. If DRS grants your application, we will issue
you a Form OR-267, Small Winery Certifi cate.
A licensed distributor of alcoholic beverages is subject to the Connecticut alcoholic beverages tax at the rate of 18¢ per wine gallon
(rather than the regular rate of 72¢ per wine gallon) if:
•
The licensed distributor is selling still wine that contains not more than 21% of absolute alcohol by volume; and
•
The still wine is produced by a winery with a Small Winery Certifi cate.
Still wine contains not more than 0.392 of a gram of carbon dioxide per hundred milliliters of wine. Alcoholic cider is a still wine if it
contains not more than 0.392 of a gram of carbon dioxide per hundred milliliters of wine.
Form REG-15 expires annually on June 30 and is renewable only if you fi le another REG-15.
If you have any questions, call the Excise/Public Services Taxes Subdivision at 860-541-3225, Monday through Friday, 8:30 a.m.
to 4:30 p.m.
Declaration: I declare, under the penalty of false statement, that I have examined this application, REG-15, and to the best of my
knowledge and belief it is true, complete, and correct. The applicant named above produced not more than 55,000 wine gallons
of wine during the preceding year. I understand that the penalty for willfully delivering a false application to DRS is a fi ne of not more
than $5,000, imprisonment for not more than fi ve years, or both.
Name of winery
By
:
Name of owner or authorized agent (Print or type.)
Title (Print or type.)
Signature of owner or authorized agent
Date
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