Form Vb-3 - Statement Of Vinous Beverages Sold To A Vermont Dealer

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VERMONT DEPARTMENT OF TAXES
PO BOX 547
MONTPELIER, VT 05601-0547
STATEMENT OF VINOUS 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
VT Dealer (Use a separate sheet for each Vermont dealer.)
Address
City
State
ZIP Code
Include Transfers and/or Credits to VT Dealers
NUMBER OF CASES BY VOLUME
INVOICE
QTS OR
GAL
1/2 GAL
MAG
5THS
PTS
10THS
20THS
JERO
4 LITRE
TOTAL
LITRE
GALLONS
4
6
6
12
12
24
24
48
4
4
Number
Date
48 - 52
27 - 33.9
19 - 26.9
15 - 18.9
11 - 14.9
0 - 10.9
101.4 -
128 OZ
64 OZ
135 OZ
OZ
OZ
OZ
OZ
OZ
OZ
104 OZ
TOTAL CASES
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
Form VB-3
Rev. 10/07

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