Form Att-75 - Donated Wine For Auction Excise Tax Report
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ATT-75 (REV. 1/2013)
DUE BY THE 10TH DAY
SUBMIT REPORT AND REMITTANCE TO:
AFTER EVENT
https://gtc.dor.ga.gov
DONATED WINE FOR AUCTION EXCISE TAX REPORT
SPECIAL EVENT LICENSE NO.
DATE OF EVENT:
NAME OF LICENSEE
ADDRESS
CITY
STATE
ZIP CODE
PHONE
REPORT IN NUMBER OF LITERS
INVENTORY OF WINE DONATED FOR AUCTION
FOREIGN WINES
DOMESTIC WINES
SUBJECT TO EXCISE TAX
14% OR LESS
OVER 14%
14% OR LESS
OVER 14%
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
$.40
$.67
$.11
$.27
Wine excise tax rate per liter by cases
12.
SUBTOTAL
13.
Total of excise tax to be remitted:
(REMIT HEREWITH)
AFFIDAVIT
I HEREBY CERTIFY, UNDER THE PENALTY OF LAW, THAT THIS IS A TRUE AND CORRECT REPORT INCLUDING
SUPPORTING SCHEDULES AND DOCUMENTS, OF ALL WINES TRANSACTIONS DURING THE CALENDAR MONTH
SHOWN ABOVE
SIGNED____________________________________ TITLE __________________________
DATE_____________
(Owner, Officer or Licensee)
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