Form Ab-605 - Refund Claim For Beverage Tax

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AB-605 – REFUND CLAIM FOR BEVERAGE TAX
(spoiled alcohol beverages unfit for consumption)
Read instructions before completing.
Legal Name
Business Name (DBA)
Tax Account Number
Address (where check should be sent)
City
State
Zip Code
PART 1 – DESCRIPTION OF SPOILED BEVERAGES AND REFUND COMPUTATION
AMOUNT OF
Line
Brand
Beverage Type
Number of Liters
Tax Rate
REFUND
Distilled Spirits
$
1
Wine ≤ 14% abv
Wine > 14% but ≤ 21% abv
Cider
Distilled Spirits
$
2
Wine ≤ 14% abv
Wine > 14% but ≤ 21% abv
Cider
Distilled Spirits
$
3
Wine ≤ 14% abv
Wine > 14% but ≤ 21% abv
Cider
Distilled Spirits
$
4
Wine ≤ 14% abv
Wine > 14% but ≤ 21% abv
Cider
Distilled Spirits
$
5
Wine ≤ 14% abv
Wine > 14% but ≤ 21% abv
Cider
Distilled Spirits
$
6
Wine ≤ 14% abv
Wine > 14% but ≤ 21% abv
Cider
7
TAX REFUND AMOUNT (add lines 1 through 6)
$
total spirit liters
admin. fee
fee to be refunded
Distilled spirits administrative fee refund amount
8
.02906 =
$
X
(multiply distilled spirits liters by administrative fee of .02906 per liter)
9
TOTAL REFUND AMOUNT (add lines 7 and 8)
$
If necessary, attach additional sheets to list the beverages for which you are claiming a refund.
PART 2 – CLAIMANT’S DECLARATION
I declare under penalties of law that the alcohol beverages listed above are spoiled and unfit for beverages purposes; that the
above information is true, correct and complete to the best of my knowledge and belief.
I swear that all the alcohol beverages listed above were destroyed in my presence on
.
Name
Title
Date
Signature
Business Telephone Number
(
)
AB-605 (R. 11-13)
Wisconsin Department of Revenue

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