Form Alc 210 B2a/s (A) - Annual Cuyahoga County Wine Tax Return For B2a And/or S Permit Holders

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ALC 210 B2a/S (A)
Rev. 5/09
P.O. Box 530
Columbus, OH 43216-0530
Annual Cuyahoga County Wine Tax Return
for B2a and/or S Permit Holders
Reporting period
Return is due on or before the last day of
the month following the reporting period.
Account number
For Department of Taxation
Use Only
Name
Address
City
State
ZIP
1. Gallons of wine sold to Cuyahoga County retailers ................................................................
2. Gallons of wine sold at retail in Cuyahoga County .................................................................
3. Subtotal (total of lines 1 and 2 multiplied by 32¢) ................................................................. $
4. Discount (.025 multiplied by line 3) ....................................................................................... $
5. Net tax (line 3 minus line 4) ................................................................................................... $
50.00
6. Late charge – $50 or 10% of line 3, whichever is greater ....................................................... $
50.00
7. Total amount due (line 5 plus line 6) ...................................................................................... $
Make check or money order payable to the Ohio Treasurer of State and mail to Ohio Department of Taxation, P.O. Box 530,
Columbus, OH 43216-0530. This return and payment must be received by the last day of the month following the reporting
period. If you have any questions concerning the Cuyahoga County wine tax return for B2a and/or S permit holders, please
contact the Ohio Department of Taxation, Excise and Energy Tax Division, P.O. Box 530, Columbus, OH 43216-0530, or call
toll-free (855) 466-3921.
I declare under penalties of perjury that this return, including any accompanying schedules and statements, has been
examined by me and, to the best of my knowledge and belief, is a true, correct and complete return and report.
Signature
Title
Date
Telephone

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