<?xml version="1.0" encoding="UTF-8"?>
<!--Sample XML file generated by XMLSpy v2010 rel. 3 sp1 (http://www.altova.com)-->
<ReturnState xsi:schemaLocation="http://www.irs.gov/efile ExciseReturnWI_BT104.xsd" xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
	<ReturnHeaderState>
		<Jurisdiction>WI</Jurisdiction>
		<Timestamp>2010-11-12T11:51:26-06:00</Timestamp>
		<TaxPeriodBeginDate>2010-06-01</TaxPeriodBeginDate>
		<TaxPeriodEndDate>2010-09-30</TaxPeriodEndDate>
		<TaxYear>2010</TaxYear>
		<Originator>
			<EFIN>991234</EFIN>
			<OriginatorTypeCd>LargeTaxpayer</OriginatorTypeCd>
		</Originator>
		<SoftwareId>v1.0</SoftwareId>
		<ReturnType>FormBT104</ReturnType>
		<Filer>
			<TIN>
				<TypeTIN>FEIN</TypeTIN>
				<TINTypeValue>391234567</TINTypeValue>
			</TIN>
			<StateEIN>308000012345601</StateEIN>
			<Name>
				<BusinessNameLine1>Sample Excise Business</BusinessNameLine1>
			</Name>
			<USAddress>
				<AddressLine1>2135 Rimrock Rd</AddressLine1>
				<City>Madison</City>
				<State>WI</State>
				<ZIPCode>53708</ZIPCode>
			</USAddress>
		</Filer>
		<BusinessRepresentative>
			<Name>
				<FirstName>John</FirstName>
				<LastName>Doe</LastName>
			</Name>
			<Title>CFO</Title>
			<Phone>6085551212</Phone>
			<EmailAddress>john.doe@sample.com</EmailAddress>
		</BusinessRepresentative>
	</ReturnHeaderState>
	<ReturnDataState>
		<FormBT104>
			<BeginningInventory>
				<Kegs>0</Kegs>
				<Cases>0</Cases>
				<TotalBarrels>0</TotalBarrels>
			</BeginningInventory>
			<EndingInventory>
				<Kegs>0</Kegs>
				<Cases>0</Cases>
				<TotalBarrels>0</TotalBarrels>
			</EndingInventory>
			<NetBarrels>
				<Kegs>70.75</Kegs>
				<Cases>91.33</Cases>
				<TotalBarrels>162.08</TotalBarrels>
			</NetBarrels>
			<TaxDue>324.16</TaxDue>
			<EligibleProducerCredit>162.08</EligibleProducerCredit>
			<NetTaxDue>162.08</NetTaxDue>
		</FormBT104>
		<SchBT101>
			<TypeOfSchedule>
				<TaxPaidSales>X</TaxPaidSales>
			</TypeOfSchedule>
			<Invoice>
				<LineNumber>1</LineNumber>
				<InvoiceDate>2010-08-23</InvoiceDate>
				<InvoiceNumber>359871</InvoiceNumber>
				<Name>Moose Distibutors</Name>
				<State>OH</State>
				<Volume>
					<Kegs>25</Kegs>
					<TotalBarrels>25</TotalBarrels>
				</Volume>
			</Invoice>
			<Invoice>
				<LineNumber>2</LineNumber>
				<InvoiceDate>2010-08-23</InvoiceDate>
				<InvoiceNumber>359974</InvoiceNumber>
				<Name>Moose Distibutors</Name>
				<State>OH</State>
				<Volume>
					<Kegs>15</Kegs>
					<TotalBarrels>15</TotalBarrels>
				</Volume>
			</Invoice>
			<Invoice>
				<LineNumber>3</LineNumber>
				<InvoiceDate>2010-08-24</InvoiceDate>
				<InvoiceNumber>25687</InvoiceNumber>
				<Name>Oak Products LLC</Name>
				<State>NE</State>
				<Volume>
					<Cases>8.66</Cases>
					<TotalBarrels>8.66</TotalBarrels>
				</Volume>
			</Invoice>
			<Invoice>
				<LineNumber>4</LineNumber>
				<InvoiceDate>2010-08-24</InvoiceDate>
				<InvoiceNumber>362458</InvoiceNumber>
				<Name>Moose Distibutors</Name>
				<State>OH</State>
				<Volume>
					<Kegs>12</Kegs>
					<Cases>5</Cases>
					<TotalBarrels>17</TotalBarrels>
				</Volume>
			</Invoice>
			<Invoice>
				<LineNumber>5</LineNumber>
				<InvoiceDate>2010-08-26</InvoiceDate>
				<InvoiceNumber>365221</InvoiceNumber>
				<Name>Moose Distibutors</Name>
				<State>OH</State>
				<Volume>
					<Kegs>8.5</Kegs>
					<TotalBarrels>8.5</TotalBarrels>
				</Volume>
			</Invoice>
			<Invoice>
				<LineNumber>6</LineNumber>
				<InvoiceDate>2010-08-30</InvoiceDate>
				<InvoiceNumber>365688</InvoiceNumber>
				<Name>Moose Distibutors</Name>
				<State>OH</State>
				<Volume>
					<Cases>5.66</Cases>
					<TotalBarrels>5.66</TotalBarrels>
				</Volume>
			</Invoice>
			<Invoice>
				<LineNumber>7</LineNumber>
				<InvoiceDate>2010-09-02</InvoiceDate>
				<InvoiceNumber>25699</InvoiceNumber>
				<Name>Oak Products LLC</Name>
				<State>NE</State>
				<Volume>
					<Cases>12.55</Cases>
					<TotalBarrels>12.55</TotalBarrels>
				</Volume>
			</Invoice>
			<Invoice>
				<LineNumber>8</LineNumber>
				<InvoiceDate>2010-09-05</InvoiceDate>
				<InvoiceNumber>366872</InvoiceNumber>
				<Name>Moose Distibutors</Name>
				<State>OH</State>
				<Volume>
					<Kegs>10.25</Kegs>
					<TotalBarrels>10.25</TotalBarrels>
				</Volume>
			</Invoice>
			<Invoice>
				<LineNumber>9</LineNumber>
				<InvoiceDate>2010-09-15</InvoiceDate>
				<InvoiceNumber>25702</InvoiceNumber>
				<Name>Oak Products LLC</Name>
				<State>NE</State>
				<Volume>
					<Cases>55.23</Cases>
					<TotalBarrels>55.23</TotalBarrels>
				</Volume>
			</Invoice>
			<Invoice>
				<LineNumber>10</LineNumber>
				<InvoiceDate>2010-09-18</InvoiceDate>
				<InvoiceNumber>25788</InvoiceNumber>
				<Name>Oak Products LLC</Name>
				<State>NE</State>
				<Volume>
					<Cases>4.23</Cases>
					<TotalBarrels>4.23</TotalBarrels>
				</Volume>
			</Invoice>
			<TotalShipmentsForMonth>
				<Kegs>70.75</Kegs>
				<Cases>91.33</Cases>
				<TotalBarrels>162.08</TotalBarrels>
			</TotalShipmentsForMonth>
		</SchBT101>
	</ReturnDataState>
</ReturnState>
