TENNESSEE DEPARTMENT OF REVENUE
WHOLESALE BEER TAX RETURN
ACCOUNT NO.
SSN or FEIN
Filing
Period
BER
Due
LOCATION ADDRESS
107
Date
Returns must be postmarked by the due
date to avoid the assessment of penalty
and interest. Returns must be filed even if
no sales were made or any tax due.
Make your check payable to the Tennes-
see Department of Revenue for the amount
shown on Line 9 and mail to:
Tennessee Department of Revenue
Andrew Jackson State Office Bldg.
500 Deaderick Street
Nashville, TN 37242
For assistance, you may call in-state toll
free 1-800-342-1003 or (615) 253-0600.
Reminders
}
1) Please read instructions on the back before preparing this return.
If this is an AMENDED RETURN,
please check the box at right
2) Maintain adequate records to support return.
3) Be sure to sign and date in the signature box below.
ROUND TO NEAREST DOLLAR
WRITE NUMBERS LIKE THIS
1. Total amount of tax collected ($35.60 per barrel) (Total of Column (c) on Schedule A) .......................... (1)
00
2. Total amount of tax paid directly to counties and cities ($34.51 per barrel) (Total of Column (d) on
00
Schedule A) ................................................................................................................................................ (2)
00
3. Vendors compensation ($0.92 per barrel) ................................................................................................. (3)
00
4. Tax due state (subtract lines 2 and 3 from Line 1) .................................................................................... (4)
00
5. Credit (Enter outstanding credit amount from previous Department of Revenue notices) ....................... (5)
00
6. Net Tax (Subtract Line 5 from Line 4) ........................................................................................................ (6)
00
{
If filed late, penalty is computed at 5% of the tax (Line 6) for each 30-day period or portion thereof that the return is delinquent.
7. Penalty
... (7)
Maximum penalty is 25% of the tax due; minimum penalty is $15 regardless of the tax amount due or whether any tax is due.
00
8. Interest (See instructions) .......................................................................................................................... (8)
00
9. Total Amount Due (Add lines 6, 7, and 8) .................................................................................................. (9)
FOR OFFICE
USE ONLY
I declare this is a true, complete, and accurate return to the best of my knowledge.
SIGN
HERE
President or other Principal Officer, Partner or Proprietor
Date
SIGN
HERE
Tax Return Preparer and Title
Date
INTERNET (7-13)
RV-R0005801