STATE 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/SDR-2017
SOFT DRINK TAX INDICIA MANUFACTURERS MONTHLY REPORT
rtL187 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.
Period Ending:
Due Date:
FINAL
AMENDED
SPECIFY INDICIA TYPE:
CARTONS
CROWNS
ENDS
LABELS
LIDS
SUMMARY OF MONTHLY TRANSACTIONS
TAX DENOMINATIONS
(Column A)
(Column B)
(Column C)
(Column D)
(Column E)
.01
.02
.04
.06
.08
1.
Opening Inventory
2.
Units Manufactured
Total Available
3.
(Line 1 plus Line 2)
4.
Closing Inventory
Total Accountable
5.
(Line 3 minus Line 4)
6.
Units Shipped
Other Disposition
7.
(explain below)
Total Disposition
8.
(Line 6 plus Line 7)
REMARKS
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
O
2
6
0
2
0
9
0
1
W