Form 610 - Cider Wholesaler'S Excise Tax Report - 2009
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1
2Indiana Department of Revenue
Cider Wholesaler’s Excise Tax Report
Reporting Month ________________ Year________________
Form 610
State Form 48913
(R2 / 3-09)
Name (As Appears on Permit)
Federal I.D. Number
Mailing Address
City
State
Zip Code
State Beer Permit Number
State Wine Permit Number
► The report is due on or before the 20th day of the month following the month being reported. ◄
GALLONS
1.
Total Gallons Received per Schedule C-1 (See Other Side).....................................................
1
2.
Deduct Total Gallons of Returns to Manufacturer or Destroyed Product (Attach Documentation)
2
3.
Deduct Total Gallons of Sales to U.S. Government Military Facilities (Attach Documentation)
3
4.
Total Deductions (Line 2 + Line 3) .............................................................................................
4
Gallons Subject to Tax (Line 1 minus Line 4) .......................................................................
5
5.
TAX
6.
Multiply Line 5 by Tax Rate of .115 ............................................................................................
6
7.
Discount *(Line 6 x .015) if timely fi led ......................................................................................
7
8.
Amount Due (Line 6 Minus Line 7) ............................................................................................
8
9.
Adjustments Auth. @ Department of Revenue (Money Only) ...................................................
9
10.
If return is fi led after due date, Add 10% of Line 8 (x.10) or $5.00 whichever is greater.
(Penalty is $5.00 if return is fi led late without tax due)............................................................... 10
11.
If return is fi led late add interest ................................................................................................ 11
12.
Total Amount Due (Line 8 + or - Line 9 + Line 10 + Line 11) Enclose your payment
for this amount .......................................................................................................................... 12
*Discount (Line 7) does not apply unless the report and payment are timely fi led.
I hereby certify, under penalty of perjury, that the information contained herein, and on supporting documents is to the best
of my knowledge true and correct.
Signature of Agent or Offi cer
Title
Date
Telephone Number
Mail To: Indiana Department of Revenue, P.O. Box 6114, Indianapolis, IN 46206-6114
Questions related to this form: Call (317) 615-2710
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