ATT-112 (Rev 7/12) |
Page _____ of _____ Pages |
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Georgia Department of Revenue |
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Due by the 15th of each |
Alcohol and Tobacco Division |
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month following month in |
Telephone: (404)417-4900 |
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which shipments were made |
E-mail: ATDIV@dor.ga.gov |
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REPORT OF WINE SHIPMENTS INTO THE STATE OF GEORGIA
DURING THE MONTH OF _____________, 20____
Submit online at https://gtc.dor.ga.gov
NAME OF WINE SHIPPER
INSTRUCTIONS
1.This report must be filed with the Georgia Department of Revenue, on or before the 15th day of each calendar month.
2.List separately, on this form, each invoice of wine shipment made or caused to be made into the State of Georgia during the calendar month for which the report is being filed, giving the information as required by this form.
3.Legible copies of all invoices of wine shipments listed on this report form must be attached.
DEPT USE ONLY
WHOLESALER’S
E.D.P. CODE
NAME & LOCATION OF
WHOLESALER TO WHOM SHIPPED
REPORT IN LITERS
14% OR LESS |
OVER 14% |
ALCOHOL BY |
ALCOHOL |
VOLUME |
BY VOLUME |
Grand Total of Shipments to Georgia Wholesalers during the month ..................................
I certify, under the penalties for filing false returns, that I have personal knowledge and understanding of statements made in this return and that the figures presented herein, including accompanying materials are true, correct and complete to the best of my knowledge and belief, and are filed in accordance with the law.
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SIGNATURE OF OWNER, PARTNER OR OFFICER |
TITLE |
DATE |
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