Form Wb-403 - Request For Beer Or Wine Destruction

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IDAHO STATE TAX COMMISSION

WB-403

TAX DISCOVERY BUREAU

EFO00123

P.O. Box 36

Boise, Idaho 83722-0036

•

06-06-08

Request for Beer or Wine Destruction

Name of Business

Employer I.D. No.

Use separate forms for beer and wine.

Check appropriate box:

Permit Number

Address

Beer to be destroyed

Wine to be destroyed

Phone Number

City, State, Zip

Strong beer to be destroyed

The unsalable merchandise is located in the warehouse of

______________________________________________________ at

Distributor

__________________________________________________ , ______________________________________________ .

Street Address

City, County

The unsalable merchandise will be destroyed on ______________ at ___________ AM/PM. _____________ total gallons will be

Date

Time

destroyed. We will take credit for these gallons on our next monthly tax return.

COMPLETE THIS TABLE. CONVERT PRODUCT SIZES TO TOTAL GALLONS.

Number of

Conversion

Container

Total Gallons

Container

Number of

Conversion

Total Gallons

Bottles

Factor

Size

of Wine

Size

Cases

Factor

of Beer

187 ml.

0.049

24/10 oz.

1.875

200 ml.

18/12 oz.

1.688

0.053

250 ml.

20/12 oz.

0.660

1.875

300 ml.

24/12 oz.

2.250

0.793

375 ml.

30/12 oz.

2.813

0.099

500 ml.

0.133

15/16 oz.

1.875

750 ml.

24/16 oz.

3.000

0.198

1.0 liter

0.264

12/22 oz.

2.063

1.5 liter

15/22 oz.

2.578

0.396

1.75 liter

12/24 oz.

2.250

0.462

3.0 liter

15/24 oz.

2.813

0.793

4.0 liter

12/32 oz.

3.000

1.056

5.0 liter

1.321

12/40 oz.

3.750

6.0 liter

1/6 BBL

5.167

1.585

18.0 liter

1/4 BBL

4.755

7.750

13.2 BBL

13.200

1/2 BBL

15.500

TOTAL GALLONS OF WINE

TOTAL GALLONS OF BEER

Multiply "Number of Bottles/Cases" by the "Conversion Factor" to equal "Total Gallons." For odd sizes, multiply the number of bottles or cases by the

container size. This equals Total Ounces, Liters or Milliliters.

Ounces:

Divide by 128 for Total Gallons.

Liters:

Multiply by .26417 for Total Gallons.

Milliliters: Multiply by .00026417 for Total Gallons.

Under penalties of perjury, I certify that the above amount is true and correct and that the beer or wine has become unsalable, has been withdrawn from the market, and

will be destroyed on the date and time shown above. I understand that I must have an approved copy of this certificate in my possession before destroying the

product(s) identified on this application. I further understand that a representative from the Idaho State Tax Commission may be present to witness the destruction.

Date

Authorized Signature

Title

Complete the upper portion of this application. Keep one copy. Mail the original and one copy to the Tax Commission 10 days before the proposed

destruction date. Don't destroy the products until you receive the approved original from the Tax Commission.

Attach a copy of the approved original form to the tax return for the month in which the beer or wine was destroyed.

FOR STATE USE ONLY

Approved by

Date

Title

Approved but not witnessed, allowed by Rules 35.01.12.021 and 35.01.09.013

Date