Form Lb56w - Wine Excise Tax Return Page 4
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5LB56W
Tax Exemptions/Other Reductions From Inventory
Schedule C
(Attach additional sheets if necessary.)
Company name
FEIN
Period of return
Minnesota tax ID number
Location code
Tax-Exempt Sales
C1
Wine (liters)
Sparkling
Date
Original
More Than
More Than
More Than
Wine
Cider
Number of
Sold
Sold to
Invoice Number 14% or Less 14% to 21% 21% to 24%
24%
(liters)
(liters)
Bottles
Total
Returns to suppliers
C2
Wine (liters)
Sparkling
Date
Original
Original
More Than
More Than
More Than
Wine
Cider
Number of
Sold
Returned to/Location Shipped
Invoice Date Invoice Number 14% or Less 14% to 21% 21% to 24%
24%
(liters)
(liters)
Bottles
Total
Authorized breakage/supervised destruction
(attach Form LB91)
C3
Wine (liters)
Sparkling
Date
More Than
More Than
More Than
Wine
Cider
Number of
Rec'd
Inspector Who Supervised Destruction
Affidavit Number
14% or Less 14% to 21% 21% to 24%
24%
(liters)
(liters)
Bottles
Total
Other reductions
C4
Wine (liters)
Sparkling
Date
More Than
More Than
More Than
Wine
Cider
Number of
Rec'd
Describe Reduction
14% or Less 14% to 21% 21% to 24%
24%
(liters)
(liters)
Bottles
Total
Total (add C1, C2, C3 and C4 totals;
enter on Form LB56W, line 5)
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Parent category: Financial