Form Reg-1 Addendum D - Alcoholic Beverages Tax

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REG-1 Addendum D
Department of Revenue Services
Connecticut Tax Registration Number
State of Connecticut
Alcoholic Beverages Tax
(Rev. 06/11)
Instructions for Addendum D
1. You must submit this addendum with Form REG-1, Business Taxes Registration Application, if your business is applying to be issued a
distributor’s license for alcoholic beverages tax purposes.
2. If your business has previously been issued a Connecticut Tax Registration Number by the Department of Revenue Services (DRS), enter
the number in the space provided and complete only Sections 1 through 6, inclusive, and Section 14 of Form REG-1.
3. While there is no fee for being issued a distributor’s license for alcoholic beverages tax purposes, your business is required to post a surety
bond or cash bond. Contact the Registration Unit at 860-297-4895 during business hours for more information about the bond.
If your business produced not more than 55,000 wine gallons of still wine containing not more than 21% of absolute alcohol during a calendar
year, your business may apply to be issued a Small Winery Certifi cate by DRS for the 12-month period beginning on the following July 1st.
File Form REG-15, Application for Small Winery Certifi cate, to apply. The alcoholic beverage tax rate on still wine containing not more than
21% of absolute alcohol and produced by a winery to which a Small Winery Certifi cate has been issued is 18¢ per wine gallon (rather than
the regular tax rate of 72¢). You may download Form REG-15 from the DRS website at
Check the category or categories below that apply to your business:
Wholesaler
: Your business has been issued a wholesaler’s permit by the Department of Consumer
Protection, Liquor Control Division (DCP) and will purchase alcoholic beverages from manufacturers
or importers and sell those beverages to retail establishments. .........................................................
Wholesaler
Manufacturer or Farm Winery
: Your business has been issued a manufacturer’s permit under
Conn. Gen. Stat. §30-16 by DCP. .......................................................................................................
Manufacturer or farm winery
Out-of-State Shipper or Out-of-State Winery Shipper:
Your business has been issued a
permit under either Conn. Gen. Stat. §30-18 or 30-18a by DCP and produce wine. If your business
intends to sell and ship wine either to retailers located in Connecticut or to consumers located in
Connecticut, you must sign the declaration below. .............................................................................
Out-of-state shipper or
out-of-state winery shipper
Brewpub:
Your business has been issued a permit under Conn. Gen. Stat. §30-16 by DCP allowing
the manufacture, storage, and bottling of beer for consumption on the premises. .............................
Brewpub
Microbrewer:
Your business has been issued a permit by DCP allowing the manufacture, storage,
and bottling of beer. ............................................................................................................................
Microbrewer
Enter the date your business will start acquiring or manufacturing alcoholic beverages or
__ __ - __ __ - __ __
start shipping wine direct to retailers or consumers in Connecticut:
m
m
d
d
y
y
Location of Connecticut business offi ce:
(If applicable)
Street address
City
Location of Connecticut warehouse:
(If applicable)
Street address
City
Location of Connecticut bonded warehouse:
(If applicable)
Street address
City
 
Approved by U.S. Treasury, Tax, and Trade Bureau .............................................................................
Yes
No
If yes, please provide valid permit number: ....................................
 
Approved by Connecticut Department of Consumer Protection, Liquor Control Division .....................
Yes
No
If yes, please provide valid permit number: ....................................
Declaration of Out-of-State Shipper or Out-of-State Winery Shipper:
I declare that I am an offi cer or agent of the applicant and
that I have been authorized by the applicant to provide the answers in this Addendum D on behalf of the applicant with the same force and
effect as if the applicant provided the answers itself. The applicant, by submission of Addendum D, consents to the jurisdiction of the State of
Connecticut, its agencies and instrumentalities, and the courts of the State of Connecticut concerning enforcement of 2005 Conn. Pub. Acts
274 and any related laws, rules or regulations, including tax laws, rules or regulations. I declare that I have examined this Addendum D and, to
the best of my knowledge and belief, it is true, complete and correct. I understand the penalty for willfully delivering a false application to DRS
is a fi ne of not more than $5,000, imprisonment for not more than fi ve years, or both.
Authorized signature
Title
Date
For DRS Use Only
Authorized signature
Date
Effective date
Bond amount

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