Form REG-1 Addendum D "Alcoholic Beverages Tax" - Connecticut

What Is Form REG-1 Addendum D?

This is a legal form that was released by the Connecticut Department of Revenue Services - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the Connecticut Department of Revenue Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form REG-1 Addendum D by clicking the link below or browse more documents and templates provided by the Connecticut Department of Revenue Services.

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Download Form REG-1 Addendum D "Alcoholic Beverages Tax" - Connecticut

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Department of Revenue Services
REG-1 Addendum D
State of Connecticut
(Rev. 06/18)
Alcoholic Beverages Tax
Entity name
Registration Confirmation # or CT Tax Registration #
Instructions
1. This addendum must be submitted with Form REG-1, Business Taxes Registration Application, if you are registering for alcoholic
beverages tax. Register on the Taxpayer Service Center (TSC) at www.ct.gov/TSC for taxes listed on Form REG-1.
File this addendum in person at any regional office or mail it to: Department of Revenue Services, PO Box 2937, Hartford, CT 06104-2937.
2. If you have been issued a Registration Confirmation Number or a Connecticut Tax Registration Number by the Department of Revenue
Services (DRS), enter the number in the space provided above and complete Form REG-1, Sections 1 through 6 and Section 14.
3. There is no fee for a distributor’s license for alcoholic beverages tax purposes. However, your business is required to post a surety bond
or cash bond. Contact DRS at 860-297-4895 during business hours.
A business producing not more than 55,000 wine gallons of still wine containing not more than 21% of absolute alcohol during a calendar
year, may qualify for a DRS Small Winery Certificate (for the 12-month period beginning on the following July 1). Complete Form REG-15,
Application for Small Winery Certificate. You may download Form REG-15 from the DRS website at www.ct.gov/drs.
Check the category or categories below that apply to your business:
Wholesaler
: Your business has or will apply for a wholesaler’s permit with the Connecticut Department of Consumer Protection,
Liquor Control Division (DCP) and will purchase alcoholic beverages from manufacturers or importers and sell those beverages to
retail establishments.
Manufacturer or Farm Winery
: Your business has or will apply for a manufacturer’s permit under Conn. Gen. Stat. §30-16 with DCP.
Out-of-State Shipper or Out-of-State Winery Shipper:
Your business has been issued a permit under either Conn. Gen.
Stat. §30-18 or Conn. Gen. Stat. §30-18a by DCP and produces wine. If your business intends to sell and ship wine either to retailers
located in Connecticut or to consumers located in Connecticut, you must sign the declaration below.
Brewpub:
Your business has or will apply for a permit under Conn. Gen. Stat. §30-16 with DCP allowing the manufacture, storage,
and bottling of beer for consumption on the premises.
Microbrewer:
Your business has or will apply for a permit with DCP allowing the manufacture, storage, and bottling of beer.
Enter the date your business will start acquiring or manufacturing alcoholic beverages or start shipping
/
/
wine direct to retailers or consumers in Connecticut: ..................................................................................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Location of Connecticut business office:
(If applicable)
Street address
City
Location of Connecticut warehouse:
(If applicable)
Street address
City
Location of Connecticut bonded warehouse:
(If applicable)
Street address
City
Approved by U.S. Treasury, Alcohol and Tobacco Tax and Trade Bureau (TTB)? ...............................
Yes
No
If Yes, enter the permit number: ....................................................................................
Out-of-State Shipper or Out-of-State Winery Shipper must be approved by DCP before submitting this application.
Enter DCP permit number: ............................................................................................
Declaration of Out-of-State Shipper or Out-of-State Winery Shipper:
I declare that I am an officer or agent of the applicant and
that I have been authorized by the applicant to provide the answers in this Addendum D on behalf of the applicant with the same force and effect as if the
applicant provided the answers itself. The applicant, by submission of Addendum D, consents to the jurisdiction of the State of Connecticut, its agencies and
instrumentalities, and the courts of the State of Connecticut concerning enforcement of Chapter 545 of the Connecticut General Statutes (Liquor Control
Act) and any related laws, rules or regulations, including tax laws, rules or regulations. I declare that I have examined this Addendum D and, to the best of
my knowledge and belief, it is true, complete and correct. I understand the penalty for willfully delivering a false application to DRS is a fine of not more than
$5,000, imprisonment for not more than five years, or both.
Authorized signature
Title
Date
Department of Revenue Services
REG-1 Addendum D
State of Connecticut
(Rev. 06/18)
Alcoholic Beverages Tax
Entity name
Registration Confirmation # or CT Tax Registration #
Instructions
1. This addendum must be submitted with Form REG-1, Business Taxes Registration Application, if you are registering for alcoholic
beverages tax. Register on the Taxpayer Service Center (TSC) at www.ct.gov/TSC for taxes listed on Form REG-1.
File this addendum in person at any regional office or mail it to: Department of Revenue Services, PO Box 2937, Hartford, CT 06104-2937.
2. If you have been issued a Registration Confirmation Number or a Connecticut Tax Registration Number by the Department of Revenue
Services (DRS), enter the number in the space provided above and complete Form REG-1, Sections 1 through 6 and Section 14.
3. There is no fee for a distributor’s license for alcoholic beverages tax purposes. However, your business is required to post a surety bond
or cash bond. Contact DRS at 860-297-4895 during business hours.
A business producing not more than 55,000 wine gallons of still wine containing not more than 21% of absolute alcohol during a calendar
year, may qualify for a DRS Small Winery Certificate (for the 12-month period beginning on the following July 1). Complete Form REG-15,
Application for Small Winery Certificate. You may download Form REG-15 from the DRS website at www.ct.gov/drs.
Check the category or categories below that apply to your business:
Wholesaler
: Your business has or will apply for a wholesaler’s permit with the Connecticut Department of Consumer Protection,
Liquor Control Division (DCP) and will purchase alcoholic beverages from manufacturers or importers and sell those beverages to
retail establishments.
Manufacturer or Farm Winery
: Your business has or will apply for a manufacturer’s permit under Conn. Gen. Stat. §30-16 with DCP.
Out-of-State Shipper or Out-of-State Winery Shipper:
Your business has been issued a permit under either Conn. Gen.
Stat. §30-18 or Conn. Gen. Stat. §30-18a by DCP and produces wine. If your business intends to sell and ship wine either to retailers
located in Connecticut or to consumers located in Connecticut, you must sign the declaration below.
Brewpub:
Your business has or will apply for a permit under Conn. Gen. Stat. §30-16 with DCP allowing the manufacture, storage,
and bottling of beer for consumption on the premises.
Microbrewer:
Your business has or will apply for a permit with DCP allowing the manufacture, storage, and bottling of beer.
Enter the date your business will start acquiring or manufacturing alcoholic beverages or start shipping
/
/
wine direct to retailers or consumers in Connecticut: ..................................................................................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Location of Connecticut business office:
(If applicable)
Street address
City
Location of Connecticut warehouse:
(If applicable)
Street address
City
Location of Connecticut bonded warehouse:
(If applicable)
Street address
City
Approved by U.S. Treasury, Alcohol and Tobacco Tax and Trade Bureau (TTB)? ...............................
Yes
No
If Yes, enter the permit number: ....................................................................................
Out-of-State Shipper or Out-of-State Winery Shipper must be approved by DCP before submitting this application.
Enter DCP permit number: ............................................................................................
Declaration of Out-of-State Shipper or Out-of-State Winery Shipper:
I declare that I am an officer or agent of the applicant and
that I have been authorized by the applicant to provide the answers in this Addendum D on behalf of the applicant with the same force and effect as if the
applicant provided the answers itself. The applicant, by submission of Addendum D, consents to the jurisdiction of the State of Connecticut, its agencies and
instrumentalities, and the courts of the State of Connecticut concerning enforcement of Chapter 545 of the Connecticut General Statutes (Liquor Control
Act) and any related laws, rules or regulations, including tax laws, rules or regulations. I declare that I have examined this Addendum D and, to the best of
my knowledge and belief, it is true, complete and correct. I understand the penalty for willfully delivering a false application to DRS is a fine of not more than
$5,000, imprisonment for not more than five years, or both.
Authorized signature
Title
Date