Brewer Importer Manufacturer Beer Barrel Tax Return {WV-BRW-01}

STATE OF WEST VIRGINIA State Tax Department, Tax Account Administration Div P.O. Box 2991 Charleston, WV 25330-2991 Earl Ray Tomblin, Governor Craig A. Griffith, Tax Commissioner Name Address City WV/BRW-01 rtL170 v.6-Web Account #: State Zip BREWER / IMPORTER / MANUFACTURER BEER BARREL TAX RETURN NOTE: This return has been redesigned. To avoid delays in the processing of this return, DO NOT use any older forms you may have. For information regarding the State Tax Department's new computer system, visit our website at www.wvtax.gov Return Due by the 10th Day of the Month Instructions: Line 1 - Record Total Barrels Sold as reported on the back of this return, converting to barrels (# Gallons ÷ 31 = # Barrels) Line 2 - West Virginia Tax Rate per Barrel of Non-Intoxicating Beer Line 3 - Compute Tax Due. (Line 1 multiplied by West Virginia Beer Barrel Tax Rate from Line 2) Line 4 - Underestimation Penalty of 1% of Line 3, if Line 7 is less than 75% of Line 3 Line 5 - Amount projected for Estimate of Tax or Total Credit to Carry Forward to next month Line 6 - Subtotal Due before Credits (Add Lines 3 plus 4 plus 5) Line 7 - Subtract the amount of Previous Estimate of Tax or Previous Total Credit (Line 5 of the preceding month's return) Line 8 - Record the difference of Line 6 less Line 7 and remit payment by the 10th of the month Due Date: FINAL AMENDED Period Ending: SECTION 1 - TAX CALCULATION 1. Total Barrels Sold to West Virginia Beer Distributors (# Gallons ÷ 31 = # Barrels) 2. West Virginia Barrel Tax Rate per Barrel 3. Balance of Tax Due (Line 1 multiplied by Line 2) 4. Underestimation Penalty (1% of Line 3 if Line 7 is less than 75% of Line 3) 5. Projected Estimate of Tax and Total Credit Carried Foward 6. Subtotal (Add Lines 3 through 5) 7. Previous Estimate of Tax and Previous Total Credit 8. TOTAL TAX DUE (Line 6 minus Line 7) . 5.50 . . . . . . Sign Your Return Under penalties of perjury, I declare that I have examined this return (including accompanying schedules and statements) and to the best of my knowledge and belief it is true and complete. (Signature of Taxpayer) (Person to Contact Concerning this Return) (Signature of preparer other than taxpayer) (Address) (Name of Taxpayer - Type or Print) (Telephone Number) (Title) (E-mail Address) (Date) (Date) MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT Tax Account Administration Div P.O. Box 2991, Charleston, WV 25330-2991 FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297 For more information visit our web site at: www.wvtax.gov File online at https://mytaxes.wvtax.gov O 3 8 0 2 0 9 0 1 W American LegalNet, Inc. www.FormsWorkFlow.com WV/BRW-01 rtL170V.6-Web BREWER / IMPORTER / MANUFACTURER BEER BARREL TAX RETURN Account #: SECTION 2 - WEST VIRGINIA BEER DISTRIBUTOR SALES INVOICE DATE INVOICE # ABCA LICENSE # DISTRIBUTOR NAME QUANTITY SOLD . . . . . . . . . . . . . . . . . . . . TOTAL SALES . Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com