Rev. 6/14 Massachusetts Form AB-10 Report of Alcoholic Beverages Shipped into Massachusetts By (name of manufacturer, brewer or wholesaler) Report for the month of Year Federal Identification number Social Security number Department of Revenue Amended return Mailing address City/Town State Zip Change of address Due within 20 days following the close of the month being reported. Mail to:PO Box 7012, Boston, MA02204. Invoice number Name and address of consignee in Massachusetts Kind of beverage Quantity in gallons Date American LegalNet, Inc. www.FormsWorkFlow.com Form AB-10 Report of Alcoholic Beverages Shipped into Massachusetts (continuation) By (name of manufacturer, brewer or wholesaler) Report for the month of Year Federal Identification number Social Security number Due within 20 days following the close of the month being reported. Mail to:PO Box 7012, Boston, MA02204. Invoice number Name and address of consignee in Massachusetts Kind of beverage Quantity in gallons Date American LegalNet, Inc. www.FormsWorkFlow.com