Form Alc 80 - Application For Refund Of Taxes On Wine And Mixed Beverages Paid In Excess Of Legal Requirements
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ALC 80
Rev. 3/01
P.O. Box 530
Columbus, OH
43216-0530
Application for Refund of Taxes
on Wine and Mixed Beverages Paid in Excess of Legal Requirements
Reporting Period
Account No.
For period of
, 20
to
, 20
, inclusive
File No.
1. Name
State File No.
2. Address
City
State
ZIP
3.
If records are located at an address other than line 2, show on line 3.
4. Federal employer identifi cation number or, if none assigned for
Federal Employee I.D. No.
Social Security No.
reporting federal taxes, please enter your social security number.
5.
Wine and Mixed
Mixed Bev.
Total
14% or Less
Vermouth
Beverages
14%-21%
21% or Less
Claimed
Sparkling
Cider
Amount claimed
0.00
Less discount, if applicable
6. Reason for claim
Total Refund
Exempt sales (complete Schedule A)
Unsaleable product (do not destroy until you have received approval from this department)
Other – please explain
I declare under penalties of perjury that this return or claim (including any accom-
For Department Use Only
panying schedules and statements) has been examined by me and, to the best
of my knowledge and belief, is a true, correct and complete return and report.
Voucher no.
Claimant
GRF
Title
Ohio grape industries
Date
State reasons for above claim and attach any necessary credit memos, invoices or other supporting evidence.
Instructions
The absence of complete records in the support of above claim will
issued to the distributors that clearly indicate the credit allowed to the
constitute a justifi able ground for disallowance of the claim.
distributor-included payment of the Ohio Excise Tax.
This claim for reimbursement must be fi led in accordance with the
Claims fi led by the distributors must be supported by credit memoranda
provisions relative thereto as set forth in Ohio Revised Code sections
received from the suppliers that clearly indicate the credit allowed the
4307.05 and 4307.07. An application shall be fi led with the tax com-
distributor did not include the Ohio excise tax.
missioner on the form prescribed by him for such purposes, within 90
Each claimant must assign a claim fi le number in numerical sequence
days from the date it is ascertained that the payment was erroneous,
starting with No. 1 in the space provided above. In this way, all claimants
or from the date that wine and mixed beverages on which taxes have
submitting refund applications will have a claim fi le number sequence
been paid have been sold in interstate or foreign commerce or have
for reference purposes.
become unsaleable; provided that in any event the application for refund
of tax erroneously paid must be fi led with the commissioner within three
Send the original and one copy to the Department of Taxation, Attn:
years from the date of such erroneous payment.
Excise and Energy Tax Division, P.O. Box 530, Columbus, OH 43216-
0530. One copy is to be retained by the claimant.
Claims fi led by the suppliers must be supported by credit memoranda
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