Form Att-112 - Report Of Wine Shipments Into The State Of Georgia
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ATT-112 (Rev 1/13)
Page _____ of _____ Pages
Due by the 15th of each
Georgia Department of Revenue
Alcohol and Tobacco Division
month following month in
Telephone: (404) 417-4900
which shipments were made
E-mail:
ATDIV@dor.ga.gov
REPORT OF WINE SHIPMENTS INTO THE STATE OF GEORGIA
DEPT. USE ONLY
DURING THE MONTH OF _____________, 20____
Submit online at
https://gtc.dor.ga.gov
NAME OF WINE SHIPPER
GA LICENSE #
ADDRESS
CITY
STATE
ZIP CODE
INSTRUCTIONS
1. This report must be filed with the Georgia Department of Revenue, on or before the 15th day of each calendar month.
2. List separately, on this form, each invoice of wine shipment made or caused to be made into the State of Georgia during the
calendar month for which the report is being filed, giving the information as required by this form.
3. Legible copies of all invoices of wine shipments listed on this report form must be attached.
INVOICE
REPORT IN LITERS
DEPT USE ONLY
NAME & LOCATION OF
14% OR LESS
CASES PER
OVER 14%
WHOLESALER’S
DATE
NUMBER
WHOLESALER TO WHOM SHIPPED
INVOICE
ALCOHOL BY
ALCOHOL
E.D.P. CODE
VOLUME
BY VOLUME
Grand Total of Shipments to Georgia Wholesalers during the month ..................................
I certify, under the penalties for filing false returns, that I have personal knowledge and understanding of statements made in this return
and that the figures presented herein, including accompanying materials are true, correct and complete to the best of my knowledge and
belief, and are filed in accordance with the law.
_____________________________________________
________________________
_____________
SIGNATURE OF OWNER, PARTNER OR OFFICER
TITLE
DATE
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