Form B-C-784m - Report Of Military Wine Sales

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F
B-C-784M
Report of Military Wine Sales
Web
North Carolina Department of Revenue
3-07
Legal Name
Account ID
Trade Name
FEIN or SSN
Address
City
Zip Code
State
Return for Month of
Contact Person
Phone Number for Contact Person
(MM - YY)
Number of Liters of Wine Sold to Military in North Carolina During Month
Invoice
Invoice
Names and Addresses of
Fortified Wine
Unfortified Wine
Date
Number
Wholesalers or Importers
(In Liters)
(In Liters)
Liters
(From Page 2)
Total Liters
(Add the total
amount of liters reported for the
month and enter the sum.)
(continued on Page 2)
Signature:
Title:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
This report must be filed if you claimed a deduction for military sales of wine on Form B-C-784, Fortified and Unfortified Wine
Excise Tax Return. The report is due on the 15th day of the month following the month in which the beverage is first sold.
North Carolina Department of Revenue, Alcoholic Beverage and Amusement Tax Unit, PO Box 25000, Raleigh, North Carolina 27640-0110

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