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STATE OF WEST VIRGINIA

State Tax Department, Tax Account Administration Div

P.O. Box 1826

Charleston, WV 25327-1826

SHEETZ INC 241_____________________________________________________________ Letter Id: L1906851840
Name
5700_____________________________________________________________6TH AVE AccountIssued:#: ________________12/31/2017
AddressALTOONA PA 16602-1111 Account #: 1026-1258
_____________________________________________________________ Period: 12/31/2017
City State Zip

CST270
rtL334 v.1 WEST VIRGINIA LOCAL WINE & LIQUOR DISTRIBUTION TAX RETURN

Period Ending: Due Date: Amended

(A) (B) (C) (D) (E)
Business Physical Retailer’s Sales TO All Other All Other
Registration Number Zip + 4 Private Clubs Wine Sales Liquor Sales
1. Single Location
2. Multi Location Retailer Schedule Totals
3. Direct Shipper/Distributor Schedule Totals
4. Subtotal Sales
5. Tax Rate 0.05 0.05 0.05
6. Tax Due (Line 4 x Line 5)
7. Total Due (From Line 6: Columns C+D+E)

Sales of wine and liquor are subject to the 6% State Sales Tax (or 6% Special District Excise Tax if applicable),
AND the Municipal Sales Tax if located within the boundaries of one of the Municipalities which impose that tax,
AND the 5% Local Wine & Liquor Distribution Tax that is reported on this return.

State and Municipal Sales Tax are reported on the CST-200CU Combined Sales & Use Tax return. Each Special District
has its own unique return for remittance of the Special District Excise Tax.

Instructions:

Retailer’s sales made to Private Clubs must be reported separately from All Other Sales as shown above.
Farm Wineries may have retailer, direct shipper and distributor sales.
1. Single location retail businesses enter the amounts of all sales from the single location identified.
2. Multiple location retail businesses enter the subtotals of all sales from the retailer location schedule.
3. Direct Shippers/Distributors enter the subtotals of all sales from the direct shipper/distributor schedule.
4. Enter the subtotal of all sales from lines 1-3 for each applicable column.
5. Multiply the amount of sales entered on line 4 by the tax rate on line 5, for each applicable column.
6. Enter the resulting amounts of tax due for each column on line 6.
7. Enter the total amount of Local Wine & Liquor Tax due by adding Columns C, D, & E of Line 6 together.

This return is not considered complete unless it is signed.
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) (Name of Taxpayer - Type or Print) (Title) (Date)
G 9 9 2 0 1 7 0 1 W
(Signature of Preparer) (Name of Preparer- Type or Print) (Phone) (Date)

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Multi Location Retailer Schedule (Retailers physically located in WV)                                   Account #: ________________
Retailer’s sales made to Private Clubs must be reported separately from All Other Sales as shown below.
     (A)          (B)                                               (C)                (D)              (E)               (F)
     Business                                                       Physical           Retailer’s Sales All Other         All Other
     Registration Physical Street Address                           Zip + 4            TO Private Clubs Wine Sales        Liquor Sales
  1
  2
  3
  4
  5
  6
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  8
  9
10
11
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13
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15
16
17
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  26                                                                Subtotals of Sales:

   Taxpayers reporting more than twenty-five (25) locations must file electronically at, www.MyTaxes.wvtax.gov.

Licensees that are physically located in WV will see their business locations preprinted on this return as they have been 
registered with the State Tax Department. If a location is not listed you may need to update or add the location.

         MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
                  Tax Account Administration Div
                  P.O. Box 1826, Charleston, WV 25327-1826
     FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
         For more information visit our web site at: www.tax.wv.gov                        G     9     9     2     0     1     7     0     2     W
                  File online at https://mytaxes.wvtax.gov

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Direct Shipper/Distributor Schedule                                                  Account #: ________________

     (A)                                     (B)                  (C)                (D)                          (E)
     Physical Street Address        Physical City                 Physical Zip + 4   Wine Sales                   Liquor Sales
  1
  2
  3
  4
  5
  6
  7
  8
  9
10
 11
12
13
14
15
16
17
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19
20
21
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23
24
25
  26                                                              Subtotals of Sales:

     Taxpayers reporting more than twenty-five (25) locations must file electronically at, www.MyTaxes.wvtax.gov.
Wine & liquor that is shipped/delivered to the customer’s location should be reported using the shipping address. 
Wine & liquor that is picked up by the customer at the licensee’s location should be reported for that location.

     MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
     Tax Account Administration Div
     P.O. Box 1826, Charleston, WV 25327-1826
     FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
     For more information visit our web site at: www.tax.wv.gov                    G     9     9     2     0     1     7     0     3     W
     File online at https://mytaxes.wvtax.gov

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