Indiana Department of Revenue
Indiana Wholesaler’s Excise Tax Report
Form 710
State Form 46926
Reporting Month ________________ Year________________
(R2 / 3-09)
Name (As Appears on Permit)
Federal I.D. Number
Mailing Address
City
State
Zip Code
State Wine Permit Number
State Liquor Permit Number
► The report is due on or before the 20th day of the month following the month being reported. ◄
GALLONS
WINE
LIQUOR
1.
Gallons per Schedule WL1 ..................................................................
1.
1.
2.
Gallons per Schedule WL2 .................................................................
2.
2.
3.
Subtotal Lines 1 and 2 ........................................................................
3.
3.
Deduct:
4.
Schedule WL3 ....................................................................................
4.
4.
5.
Schedule WL4 ....................................................................................
5.
5.
6.
Subtotal Lines 4 and 5 ........................................................................
6.
6.
Gallons Subject to Tax (Subtract Line 6 from Line 3) ...................
7.
7.
7.
TAX
8.
Multiply Line 7 by Tax Rate .................................................................
8.
8.
($2.68 for Liquor, $ .47 for Wine)
9.
Discount (Line 8 x .015) if fi led timely .................................................
9.
9.
10.
Net Amount Due (Line 8 - Line 9) ........................................................ 10.
10.
Total Wine and Liquor Taxes Due ....................................................
11.
11.
12.
Adjustments Auth. @ Dept. of Revenue (Money Only Supporting Documents must be attached .......
12.
13.
Penalty: If return is fi led after due date, add penalty. Penalty is 10% of Line 11 or $5.00 whichever
is greater. .............................................................................................................................................
13.
14.
Interest: If return is fi led after due date, add interest Call the Department of Revenue at
(317) 232-2240 for interest amount......................................................................................................
14.
15.
TOTAL AMOUNT DUE: (Add Line 11 + or - Line 12 + 13 and 14) ......................................................
15.
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 the form: Call (317) 615-2710