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-2015
SOFT DRINK MONTHLY REPORT
rtL186 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.
All Lines Must Be Completed
Period Ending:
Due Date:
FINAL
AMENDED
TAX CALCULATION
Column A
Column B
Column C
Column D
Syrups
Powders
Prepared Drinks
Total (A + B + C = D)
(Bottlers Only)
Gross Tax Due
1.
.
.
.
.
Less Exports Tax Not Paid
2.
.
.
.
.
Balance of Gross Tax Due
3.
.
.
.
.
(Line 1 minus Line 2)
4.
Credits (Line F - Prepayment of Stamps And/Or Crowns from WV/SDR 2015 SUP)
.
5.
Discount (Line 3 Column C multiplied by 0.1250) BONDED BOTTLERS ACCOUNTS ONLY
.
6.
Net Tax Due (Line 3 minus Line 4 and Line 5)
.
Tax Paid Out-of-State Shipments (Exports)
7.
.
8.
Balance of Tax Due (Line 6 minus Line 7 - If less than zero, enter zero)
.
9.
NON-WAIVABLE INTEREST
.
10.
ADDITIONS TO TAX
.
11.
TOTAL TAX AND LATE FILING CHARGES DUE (Add Lines 8, 9 and 10)
.
REQUEST FOR REFUND
12.
(Line 7 minus Line 6 - If less than zero, enter zero)
.
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
2
0
2
0
9
0
1
W