This form must be completed and submitted to the Nebraska Liquor Control Commission by January 25th of each year reporting all juice gallons produced and/or received in the preceding year by each farm winery per State Statute 53-304. Retain a copy for your files. Our office no longer accepts checks for any excise tax/crush return payments. You will NOT get confirmation that this form has been submitted, but you will get confirmation that payment has been made. You MUST fill out the form to make a payment. Farm Winery DBA Name Required Neb. License Number Required Reporting Year Required Address Required City Required State Required AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip Code Required Email Address Required 1: Total Juice Gallons (All Fruits) Produced or Received for Calendar Year Required 2: Divide Total Juice Gallons (Line 1 divided by 160) 3: Multipy Line 2 by $20.00 $ 4: Total Amount Due $ You will NOT get confirmation that this form has been submitted, but you will get confirmation that payment has been made. You MUST fill out the form to make a payment. Security Authentication Required For security purposes, you must complete the recaptcha before submitting the comment form. Make Payment Reset You will NOT get confirmation that this form has been submitted, but you will get confirmation that payment has been made. You MUST fill out the form to make a payment.
