Form Lb56f - Farm Winery Tax Return Page 4
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5LB56F
Company name
FEIN
Period of return
Minnesota tax ID number
Location code
Tax Exemptions/Other Reductions From Inventory
Schedule C
(Attach additional sheets if necessary.)
Tax-Exempt Sales
C1
Wine (liters)
Sparkling
Number of
Date
Original
More Than
More Than
More Than
Wine
Cider
Bottles
Sold
Sold To
Invoice Number 14% or Less 14% to 21% 21% to 24%
24%
(liters)
(liters)
(200 ml or more)
Total
Authorized Breakage/Supervised Destruction
C2
(attach Form LB91)
Wine (liters)
Sparkling
Number of
Date
Affidavit
More Than
More Than
More Than
Wine
Cider
Bottles
Rec'd
Inspector Who Supervised Destruction
Number
14% or Less 14% to 21% 21% to 24%
24%
(liters)
(liters)
(200 ml or more)
Total
Other Reductions
C3
Wine (liters)
Sparkling
Number of
More Than
More Than
More Than
Wine
Cider
Bottles
Date
Describe Reduction
14% or Less 14% to 21% 21% to 24%
24%
(liters)
(liters)
(200 ml or more)
Total
Schedule C Total (add C1, C2 and C3 totals)
(enter on Form LB56F, line 5)
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