Form Abc-20 - Individual'S Gallonage Tax Return Wine Purchased In Person At Any Out-Of-State Winery Page 2
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3Kansas Department of Revenue
Alcoholic Beverage Control Division
915 S.W. Harrison Street, Room 214
Topeka, KS 66625-3512
Phone: 785-296-7015 Fax: 785-296-7185
INDIVIDUAL’S GALLONAGE TAX RETURN
WINE PURCHASED IN PERSON AT ANY OF OUT-OF-STATE WINERY
PART A – GALLONAGE TAX RETURN
As required by K.S.A. 41-104(g) and 41-501(b)(2)
NAME: ________________________________________________SSN: ______________________
ADDRESS: _______________________________________________________________________
City
State
PHONE: _______________________________________________FAX: ______ _______________
EMAIL ADDRESS: ________________________________________________________________
TRANSPORTING FROM ADDRESS: __________________________________________________
City
State
TRANSPORTING TO ADDRESS: _
__________________________________________________
City
State
TRANSPORTATION DATE(S): _______________________________________________________
PRODUCT TYPE:
NUMBER OF
TAX RATE PER
TAX AMOUNT:
WHOLE
GALLON:
GALLONS:
Fortified Wine
(IOWF)
X
$0.75
=
$
Light Wine
X
$0.30
=
$
(IOWL)
TOTAL GALLONAGE TAX DUE =
$
I have calculated the Kansas Gallonage Tax imposed by K.S.A. 41-501 et seq for the wine listed
above that I have purchased at an out-of-state winery and have shipped or transported into the State
of Kansas. I certify that this wine is for the personal use of my family, my guests and myself and not
for resale within the State of Kansas.
Attached is my check, bank draft or money order payable to the “Kansas Department of Revenue”.
I declare under penalties of perjury that to the best of my knowledge and belief this is a true, correct
and complete return.
Signature
Date
ABC USE ONLY:
Approved By
Date
ABC-207 (Rev. 7.1.11)
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