Form Wv/frm-01 - West Virginia Licensed Farm Wineries Production Report
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1STATE OF WEST VIRGINIA
State Tax Department, Tax Account Administration Div
P.O. Box 2991
Charleston, WV 25330-2991
Name
Address
Account #:
City
State
Zip
WV/FRM-01
WEST VIRGINIA LICENSED FARM WINERIES PRODUCTION REPORT
rtL168 v 3-web
Taxpayers required to file electronically will no longer receive returns for the tax types subject to the mandatory
requirement by mail. Please visit for additional information.
This report must be filed even if no activity has occurred
West Virginia Legislative Regulations, Title 175, Series 3
-4.11 "Every licensed farm winery shall report its total gallonage of wine produced or blended for the twelve
(12) month period ending June 30 of each year or partial year. Such report shall be submitted by letter report
within thirty (30) days after the end of such fiscal year."
For your convenience, the information may be reported monthly. Information contained on this form should
show the same quantities as ATF Form 702, Part 1, Line 2.
Period Ending:
Due Date:
FINAL
AMENDED
TOTAL PRODUCTION
GALLONS OF WINE PRODUCED BY FERMENTATION
.
Sign Your Return
Under penalties of perjury, I declare that I have examined this return (including accompanying schedules and statements) and to the
best of my knowledge and belief it is true and complete.
(Signature of Taxpayer)
(Name of Taxpayer - Type or Print)
(Title)
(Date)
(Person to Contact Concerning this Return)
(Telephone Number)
(E-mail Address)
(Signature of preparer other than taxpayer)
(Address)
(Date)
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
Tax Account Administration Div
P.O. Box 2991, Charleston, WV 25330-2991
FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
For more information visit our web site at:
File online at https://mytaxes.wvtax.gov
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