Form Wv/ber-01 - Distributor/wholesaler Of Beer Barrel Report Page 2
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3WV/BER-01
DISTRIBUTOR / WHOLESALER OF BEER BARREL REPORT
rtL171V 3-web
Account #:
SECTION 2 - TRANSFERS IN (DISTRIBUTOR)
TOTAL
INVOICE DATE
INVOICE #
ABCA LICENSE #
BREWER NAME
BARRELS
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.
.
.
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.
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SECTION 3 - TRANSFERS OUT (DISTRIBUTOR)
TOTAL
INVOICE DATE
INVOICE #
ABCA LICENSE #
BREWER NAME
BARRELS
.
.
.
.
.
.
.
.
.
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)
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