Form Wv/sdr-2015 Sup - Additional Accountability Of Prepaid Taxable Crowns, Caps, Containers, Or Stamps

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WV/SDR-2015 SUP
West Virginia Department of Tax and Revenue
Rev. 10/09
ADDITIONAL ACCOUNTABILITY OF PREPAID TAXABLE CROWNS, CAPS, CONTAINERS, OR STAMPS
(Designated as a single unit and not including crowns on floor stock)
ACCOUNT NAME: ______________________________________________________________________ Month of ___________________________________, 20_________
DENOMINATION
A. ON HAND
FIRST OF MONTH
B. PURCHASES/
RECEIPTS
C. AVAILABLE
(Add Lines A & B)
D. ON HAND END
OF MONTH
E. NUMBER
AFFIXED
F. DOLLAR
VALUE
DENOMINATION
A. ON HAND
FIRST OF MONTH
B. PURCHASES/
RECEIPTS
C. AVAILABLE
(Add Lines A & B)
D. ON HAND END
OF MONTH
E. NUMBER
AFFIXED
F. DOLLAR
VALUE
CERT.
MFG/SUPPLIER:
CERT.
MFG/SUPPLIER:
AMOUNT
AMOUNT
(Crowns, Lids, & Cartons)
NO.
NO.
(Crowns, Lids, & Cartons)

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