INSTRUCTIONS DIRECT SHIPPER STATEMENT
All Direct Shipper transactions must be reported on this Statement.
Name - Trade Name as it appears on your OLCC license
Month - Month report refers to
Year - Year report refers to
Address - Physical address of Licensed Premise (do not enter mailing address)
City & State - City and State of premise physical address
OLCC License Number - OLCC license number of current certificate
Complete the information for each column as needed. Taxable Product shipped into Oregon (Line 1) -Taxable product total from Schedule 11 Authorized Deductions (Line 2) - Authorized deductions totals from Schedule 12 Total Taxable Distribution (Line 3) - Line 1 Minus Line 2
Rate of Tax (Line 4) - Current Rate of tax
Amount of Tax (Line 5) - Line 3 multiplied by Line 4 Total Tax (Line 6) - Total of Columns A, B & C - Line 5
Other Additions (or Deductions) (Line 7) - Adjustments regarding error letters received from OLCC Penalty (Line 8) - Penalty due on late reports or errors
Interest (Line 9) - Interest due on late reports or errors
Audit Adjustments (Line 10) - Audit adjustments as indicated on your audit report
Total Tax, Penalty and Other Items Due (Line 11) - Total of Line 6 to Line 10 - Enclose remittance
Certification - Required declaration of accurate and complete statement
Official Position - Position Title for legal entity (For example, Owner, President, etc.) Licensee - Trade Name of the company as it appears on your OLCC license Phone Number - Number at which licensee can be reached
Signature - Signature of person listed in Official Position Printed Name - Printed name of person listed in Official Position
This report must be completed monthly by all Direct Shippers. The report must be postmarked on or before the 20th of the month following the reporting period. When the 20th falls on a Saturday, Sunday, or a legal holiday, the filing must be postmarked by the U. S. Postal Service no later than the next postal business day.
When reporting Barrels/Gallons, carry the decimal to two places.
Decimals of .005 or larger should be rounded up. Example 12.387 would be reported as 12.39.
Decimals of .004 and lower should be dropped. Example 12.384 would be 12.38.