Form R-5697 - Schedule 1 - Sparkling Wines Shipped Direct To Louisiana Consumers

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R-5697 (7/07)
Page _______ of _______
Schedule 1
Sparkling Wines Shipped
Direct to Louisiana
Consumers
List sparkling wines and include still wines having
an alcohol content of more than 24% by volume.
PLEASE PRINT OR TYPE.
Company Name
LA Revenue Account Number
Filling Period (MM/DD/YYYY)
Number
Bottle
Invoice
Customer
of Bottles
Size
Price per
Total Liters
Date
Number
Customer Name
Address
Brand Name
Shipped
(volume)
Bottle
Shipped
Total

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