FORM Maryland Direct Wine Shipper 2012 315 Tax Return

123150049

Direct Wine Shipper’s Name Federal Employer ID Number (FEIN) - Office Use Only Street Address Check Number______

Amount $______City State ZIP code Deposit Date______

E-mail Address

Direct Wine Shipper’s Permit Number For Calendar Quarter January – March April – June DW- July – September October - December TAX DETERMINATION SUMMARY OF WINE / POMACE BRANDY SALES TO CONSUMERS IN MARYLAND DURING REPORT QUARTER

I. tOTAL NUMBER OF GALLONS OF WINE SOLD TO CONSUMERS – TAX CALCULATION Convert Total Liters to Total Gallons by conversion factor of 0.264. One liter = 0.264 gallons. For example, one case of 750 ml bottles (12 bottles per case) = 9 liters x 0.264 = 2.376 gallons.

1. Conversion Calculation: total Liters Sold by Case or Bottle: ______x 0.264 = ______Total Gallons Sold

2. Total Gallons Sold (from line 1):...... 2. ______

3. Adjustments:...... 3. ______

4. Net Gallons subject to alcoholic beverage tax (line 2 plus or minus line 3) ...... 4. ______

5. Wine tax per gallon...... 5. x .40

6. WINE TAX DUE (multiply line 4 by line 5)...... 6. $______

II. Total number of gallons of Pomace Brandy sold to consumers - TAX CALCULATIONS Convert Total Liters to Total Gallons by conversion factor of 0.264. One liter = 0.264 gallons. For example, one case of 750 ml bottles (12 bottles per case) = 9 liters x 0.264 = 2.376 gallons.

7. Conversion Calculation: total Liters Sold by Case or Bottle: ______x 0.264 = ______Total Gallons Sold

8. Total Gallons Sold (from line 7):...... 8. ______

9. Adjustments:...... 9. ______

10. Net Gallons subject to alcoholic beverage tax (line 8 plus or minus line 9) ...... 10. ______

11. Pomace Brandy tax per gallon ...... 11. x 1.50

12. POMACE BRANDY TAX DUE (multiply line 10 by line 11) ...... 12. $______

13. TOTAL TAX DUE (add line 6 and line 12) ...... 13. $______

I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing document are true and correct to the best of my knowledge, information and belief.

Print name______Title: Owner, Partner or Officer______

Signature ______Date______

COM/RAD-315 Rev. 08/12 American LegalNet, Inc. Page 1 www.FormsWorkFlow.com FORM Maryland Direct Wine Shipper Page 2 315 Tax Return 2012 123150149 Direct Wine Shipper’s Name Federal Employer ID Number (FEIN) - A B C D E F G Date of Date of Brand of Wine/ Price Name of Address of Total Sale Shipment Pomace Brandy Charged Consumer Shipped to Consumer Shipped to Liters Sold

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In lieu of using this form to report each sale, a hard-copy report with the same information may be submitted.

COM/RAD-315 Rev. 08/12 American LegalNet, Inc. www.FormsWorkFlow.com FORM INSTRUCTIONS - maryland DIRECT Page 3 315 WINE SHIPPER’S TAX RETURN 2012

This tax return, together with payment of the wine/pomace 12 Pomace Brandy tax due (multiply line 10 by line 11) brandy tax due, shall be properly filed and physically received 13 Total tax due (add line 6 and line 12) by the Revenue Administration Division no later than the 10th day of the month following the quarter in which wine/pomace Page 2 – Each Wine/Pomace Brandy Sale to Consumers brandy was sold and shipped to consumers in Maryland. Column Line tax Period Due Date A 1-14 Date of sale of wine/pomace brandy to January – March April 10th consumer April – June July 10th July – September October 10th B 1-14 Date of shipment of wine/pomace October – December January 10th brandy to consumer Payment shall be in the form of a check or money order payable C 1-14 Brand of wine/pomace brandy sold. to the “Comptroller of Maryland”. State name of each brand of wine/ pomace brandy and varietal sold Page 1, Part I – Wine Tax Determination – Summary of Wine Sales to Consumers in Maryland D 1-14 Price charged Line E 1-14 Name of consumer shipped to on shipping label 1 Convert total liters of wine sold to total gallons by multiplying amount by 0.264. For example, one case F 1-14 Address of consumer shipped to on of 750 ml bottles (12 bottles per case) = 9 liters x shipping label 0.264 = 2.376 gallons G 1-14 Total liters of wine/pomace brandy sold 2 Total Gallons Sold (from Line 1) to address of consumer shipped to 3 Adjustments (if taking a debit or credit, please submit This tax return must be signed by the owner, partner, or officer supporting documentation) of the corporation. 4 Net gallons of wine subject to alcoholic beverage tax If this is a corporation, an officer (President, Vice President, (Line 2 plus or minus Line 3 adjustments) Secretary or Treasurer) must sign. 5 Maryland wine tax rate of $0.40 per gallon Mail tax return to: 6 Wine tax due (Multiply Line 4 by Line 5) Comptroller of Maryland Revenue Administration Division Page 1, Part II - Pomace Brandy Tax Determination- Returns Processing Summary of Pomace Brandy Sales to Consumers in P.O. Box 2999 Maryland Annapolis, Maryland 21404 “Pomace brandy” is defined as “brandy that is distilled from For more information: the pulpy residue of the wine press, including the skins, pips, Telephone: 410-260-7690 or 1-800-638-2937 and stalks of grapes.” Fax: 410-260-7924 7 Convert total liters of Pomace Brandy sold to total compnet.comp.state.md.us gallons by multiplying amount by 0.264. For example, www.marylandtaxes.com one case of 750 ml bottles (12 bottles per case) = 9 liters x 0.264 = 2.376 gallons 8 Total Gallons Sold (from Line 7) 9 Adjustments (if taking a debit or credit, please submit supporting documentation) 10 Net gallons of Pomace Brandy subject to alcoholic beverage tax (line 8 plus or minus line 9) 11 Maryland distilled spirit tax rate of $1.50 per gallon

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