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Acters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS) NCDOR ID/Account Number Trade Name Mailing Address Wine Shipper/ABC Permit Number City State Zip Code State of Domicile Name of Contact Person Phone Number Fax Number Part 1. Computation of Unfortified and Fortified Wine Excise Tax 1. Liters Sold to North Carolina Customers Pursuant to Wine Shipper Permit (From Part 2, Total) 1. 2. Liters Sold on Premises of Resident Wineries and/or to Retailers (From Part 3, Tot.

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