Form Dws 726 - Direct Wine Sellers Excise Tax Report
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1
2Indiana Department of Revenue
For Departmental Use Only
A. _______________
DWS 726
B. _________________
Direct Wine Sellers Excise Tax Report
C. _________________
Form 726
(For Sellers Located Outside of Indiana)
State Form 52715
(R3 / 3-09)
Reporting Month ________________Year _________
(This return is due by the 20th day after the end of the reporting month, even if there is zero activity.)
Federal Identification Number
Name
Tax Identification Number
Mailing Address
City
State
Zip Code
Federal Permit Number
Direct Wine Permit Number
(if applicable)
GALLONS (Enter whole numbers, no decimals.)
1. Direct Wine Gallons Sold (from Schedule DWS 726 - Type A)
1. ______________
2. Exempt Gallons Sold for Sacramental Purposes (from Schedule DWS 726 - Type B)
2. ______________
3. Gallons Returned to Winery (from Schedule DWS 726 - Type C)
3. ______________
4. Gallons Subject to Tax: Line 1 minus Lines 2 and 3
4. ______________
TAX
5. Multiply Subject Gallons by Tax Rate: Line 4 times $0.47
5. ______________
6. Timely Payment Discount 1.5%: Line 5 times .015
6. ______________
7. Tax Due: Line 5 minus Line 6
7. ______________
8. Adjustments Authorized by the Department of Revenue
8. ______________
9. Penalty: If return or payment is received after the due date, add a
penalty of 10% of the tax due or $5.00, whichever is greater
9. ______________
10. Interest: Add interest if return is filed late. (call (317) 615-2710 for
calculation instructions)
10. ______________
11. Total Amount Due: Line 7 + or - Line 8 + Line 9 + Line 10
11. ______________
Make check payable to: Indiana Department of Revenue
I declare, under penalty of perjury, that this is a true, correct and complete form.
_______________________________________________________________________________________
Name of Agent or Officer
Signature of Agent or Officer
_______________________________________________________________________________________
Date
Telephone Number
☐
Mail to: Indiana Department of Revenue
(check if)
P.O. Box 6114
Final Return
Indianapolis, Indiana 46206-6114
Close Date __________________
Questions related to this form: Call (317) 615-2710
If business account is closed, fill out a BC-100 (See instructions).
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