<?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_TT114.xsd" xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
	<ReturnHeaderState>
		<Jurisdiction>WI</Jurisdiction>
		<Timestamp>2010-11-10T11:51:26-06:00</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>FormTT114</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>
		<FormTT114>
			<Purchases>
				<LineNumber>1</LineNumber>
				<InvoiceDate>2010-07-07</InvoiceDate>
				<InvoiceNumber>2351144</InvoiceNumber>
				<PurchasedFrom>Mouse Tobacco</PurchasedFrom>
				<WIPermitNumber>400123456789001</WIPermitNumber>
				<FromCity>Green Bay</FromCity>
				<InvoicePrice>54.87</InvoicePrice>
			</Purchases>
			<Purchases>
				<LineNumber>2</LineNumber>
				<InvoiceDate>2010-08-03</InvoiceDate>
				<InvoiceNumber>2352596</InvoiceNumber>
				<PurchasedFrom>Mouse Tobacco</PurchasedFrom>
				<WIPermitNumber>400123456789001</WIPermitNumber>
				<FromCity>Green Bay</FromCity>
				<InvoicePrice>54.87</InvoicePrice>
			</Purchases>
			<Purchases>
				<LineNumber>3</LineNumber>
				<InvoiceDate>2010-08-31</InvoiceDate>
				<InvoiceNumber>2354091</InvoiceNumber>
				<PurchasedFrom>Mouse Tobacco</PurchasedFrom>
				<WIPermitNumber>400123456789001</WIPermitNumber>
				<FromCity>Green Bay</FromCity>
				<InvoicePrice>54.87</InvoicePrice>
			</Purchases>
			<Purchases>
				<LineNumber>4</LineNumber>
				<InvoiceDate>2010-09-14</InvoiceDate>
				<InvoiceNumber>2354789</InvoiceNumber>
				<PurchasedFrom>Mouse Tobacco</PurchasedFrom>
				<WIPermitNumber>400123456789001</WIPermitNumber>
				<FromCity>Green Bay</FromCity>
				<InvoicePrice>54.87</InvoicePrice>
			</Purchases>
			<GrandTotalQuarter>219.48</GrandTotalQuarter>
		</FormTT114>
	</ReturnDataState>
</ReturnState>
