Form B-C-784 - Wine Distributor Excise Tax Return
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1
2Wine Distributor Excise Tax Return
B-C-784
Web
North Carolina Department of Revenue
8-12
DOR Use Only
FEIN or SSN
Return for
Month Ended
(MM-DD-YY)
Legal Name (First 35 Characters)
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
NCDOR ID/Account Number
Trade Name
Mailing Address
Wine Shipper/ABC Permit Number
State
City
Zip Code
State of Domicile
Name of Contact Person
Fill in circle if applicable:
Fax Number
Phone Number
Amended Return
Part 1. Computation of Unfortified and Fortified Wine Excise Tax
Unfortified Wine
Fortified Wine
,
,
,
,
1.
Beginning Inventory (In liters)
1.
,
,
,
,
2.
Total Liters Received (From Part 2, Total)
2.
,
,
,
,
3.
Total Liters Available
3.
Add Lines 1 and 2
,
,
,
,
4.
a.
Allowable Deductions (Attach Schedule)
4a.
,
,
,
,
b.
Adjustments to Taxable Transactions
4b.
(Attach Schedule)
,
,
,
,
c.
Military Sales (From Part 3, Total)
4c.
,
,
,
,
d.
Ending Inventory (In liters)
4d.
,
,
,
,
5.
Total Taxable Liters
5.
Line 3 minus Lines 4a - 4d
6.
Tax Rate
6.
26.34¢
29.34¢
.
.
,
,
,
,
7.
Total Excise Tax Due
7.
00
00
7.
7.
Multiply Line 5 by applicable tax rate on Line 6
.
.
8.
Discount
,
,
,
,
Multiply Line 7 by 2% if return with full
8.
00
00
payment is timely filed; otherwise enter zero.
.
.
,
,
,
,
9.
Net Tax Due
00
00
9.
Line 7 minus Line 8
.
.
10.
Penalty (10% for late payment; 5% per month,
,
,
,
,
maximum 25%, for late filing) Multiply Line 7 by
00
00
10.
rate above if return with full payment is not filed timely.
.
.
Interest (See the Department’s website, ,
11.
,
,
,
,
for current interest rate.) Multiply Line 7 by applicable rate
00
00
11.
if return with full payment is not filed timely.
.
.
,
,
,
,
12.
Total Due
00
00
12.
Add Lines 9 through 11
.
,
,
13.
Total Payment Due
13.
00
Add Line 12 for both Unfortified and Fortified Wine
Signature:
Title:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
For your convenience, electronic payment methods are available through our website at .
North Carolina Department of Revenue, Post Office Box 25000, Raleigh, North Carolina 27640-0110
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