Form Wv/dis-01 - West Virginia Wine Distributor'S Report Page 3
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3WV/DIS-01
WEST VIRGINIA WINE DISTRIBUTOR'S REPORT
rtL167V 8 Web
SCHEDULE C - TRANSFERS OUT (List Only Sales To Other WV Distributors)
INVOICE DATE
SUPPLIER
LOCATION
INVOICE NUMBER
TOTAL LITERS
.
.
.
.
.
.
Total Schedule C (Enter here and on Page 1 Line 7)
.
Below is the former return WV/BLS-01
List below an account of the merchandise included in Page 1 Line 6-A of the Distributor's Summary of Wine Purchases, Sales
and Inventory (WV/DIS-01), submitted to the West Virginia Department of Tax and Revenue for the reporting period.
SCHEDULE D - DISTRIBUTOR'S BREAKAGE, LEAKAGE, SPOILAGE & SHORTAGES
Enter Total only for Breakage, Leakage, Spoilage & Shortages. Itemization is not required.
(Enter here and on Page 1 Line 6-A)
.
SCHEDULE E - DISTRIBUTOR'S SAMPLES TO RETAILERS
(Itemization is required. Enter each sample given in the reporting period as a separate item)
Quantity
Extended
Size
Date
Retailer
License Number
Brand Name
(Bottles)
Liters
Enter Total Samples to Retailers (in Liters) (Enter here and on Page 1 Line 6-B)
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