Statement Of Malt Beverages Sold To Vermont Dealer
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Statement Of Malt Beverages Sold To Vermont Dealer Form. This is a Vermont form and can be use in Department Of Taxes Statewide.
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Tags: Statement Of Malt Beverages Sold To Vermont Dealer, MB-3, Vermont Statewide, Department Of Taxes
VERMONT DEPARTMENT OF TAXES
PO BOX 547
MONTPELIER, VT 05601-0547
STATEMENT OF MALT BEVERAGES SOLD TO A VERMONT DEALER
For month of __________________, 20______
File this report on or before the 20th of each month.
Distributor
Distributor’s Address
City
State
ZIP Code
City
State
ZIP Code
VT Dealer (Use a separate sheet for each Vermont dealer.)
Address
Include Transfers and/or Credits to VT Dealers
INVOICE
Number
KEGS
Date
1/2
1/4
CASES
13.2
12
12
24
24
12
Gals.
40 oz.
32 oz.
16 oz.
12 oz.
12 oz.
TOTAL
GALLONS
24
7 oz.
TOTALS
I declare, under penalties of perjury, that this return (including any accompanying schedules and statements) is true, correct, and
complete to the best of my knowledge.
Distributor Signature
Date
Prepared by (Print or Type)
Title
Rev. 10/07
Form MB-3
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