TENNESSEE DEPARTMENT OF REVENUE
WINE TAX RETURN
Account No.
Filing Period
SSN OR FEIN
ALC
Beginning:
105
Due Date
Ending:
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
Tennessee Department of Revenue for
the amount shown on Line 6 and mail to:
Tennessee Department of Revenue
Andrew Jackson State Office Bldg.
500 Deaderick Street
Nashville, TN 37242
REMINDERS
1) Please read instructions on reverse side before preparing this return.
2) Maintain adequate records to support return.
3) Transfer the amounts reported in the worksheet to the corresponding item numbers in the bottom portion.
4) Be sure to sign and date your return in the signature box on the back of the form.
WORKSHEET FOR COMPUTING TAX
ROUND TO THE NEAREST DOLLAR
GALLONS TO FOUR DECIMAL PLACES
1. Taxable sales in gallons (from Schedule A, Line 7) .................................................................................. (1)
________________________
$
2. Tax due - Multiply Line 1 by the tax rate ($
) ........................................................................................ (2)
________________________
$
3. Credits (if applicable) .................................................................................................................................. (3)
________________________
$
4. Penalty (if filed late, see instructions on reverse side) .............................................................................. (4)
________________________
$
5. Interest (If filed late, see instructions on reverse side; current interest rate per annum is
%) ...... (5)
________________________
$
6. Total remittance amount (Add lines 2, 4, and 5; subtract Line 3) .............................................................. (6)
________________________
Keep Upper Portion For Your Records
ROUND TO NEAREST DOLLAR
WRITE NUMBERS LIKE THIS
Return Copy Below - Detach Here
TENNESSEE DEPARTMENT OF REVENUE
ALC
WINE TAX RETURN
Filing
Due
1. TAXABLE SALES IN GALLONS
105
Period
Date
ACCOUNT NO.
2. TAX DUE
00
3. CREDITS
00
00
4. PENALTY
If an amended
return, check
box above
FOR OFFICE
00
5. INTEREST
USE ONLY
00
6. TOTAL AMOUNT REMITTED
105970001
INTERNET (8-05)
RV-R0005701