Direct Shipping Monthly Report Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Direct Shipping Monthly Report Form. This is a New Hampshire form and can be use in Liquor Commission Statewide.
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Tags: Direct Shipping Monthly Report, New Hampshire Statewide, Liquor Commission
State of New Hampshire Liquor Commission
Direct Shipping Monthly Report
Mailing Address:
Division of Enforcement
Direct Shipping
PO Box 1795
Concord NH 03302-1795
Name of Shipper:
Physical Address:
Division of Enforcement
Direct Shipping
57 Regional Drive Suite #8
Concord NH 03301
Contact Info:
Tel: (603) 271-8543
Fax: (603) 271-8424
directshippers@liquor.state.nh.us
Address:
Permit #
For the Month of
This report must be filed once per month for any month in which a shipment was made
so as to arrive at the New Hampshire Liquor Commission on or before the 15th of the following month.
Attach to this report a check in the amount of the "Total Amount Due" payable to the
New Hampshire Liquor Commission and copies of all invoices shipped into NH.
Total # of invoices shipped into NH:
Retail Price including
shipped costs
Less
shipped costs
Retail
Price
Beer
-
=
Liquor
-
=
Wine
-
=
Total
-
=
X
0.08
Total Fee at 8%
*** NH Liquor Commission issued debit/credit memos
Total Amount Due
The undersigned hereby swears and affirms that all statements made herein are true and correct to the
best of my knowledge and belief and understand that this statement is made subject to the penalties of
unsworn falsification described in RSA 641:3.
Compliance Company Info:
Name:
Owner or Officer
Address:
Contact:
*** ( Attach the white copy of the debit/credit memos )
D-006 (Rev 3/8/11)
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