Form Mt-52 Schedule D - Tax-Free Sales

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MT-52

New York State Department of Taxation and Finance

Beer and Similar Fermented Malt Beverages

Schedule D — Tax-Free Sales

(10/09)

Period covered by this schedule

Legal name

Beer tax registration number

Federal EIN or social security number

See Form MT-50-I, Instructions for Form MT-50, for assistance in completing this schedule.

Complete this schedule and attach it to Form MT-50, Beer Tax Return (and Similar Fermented Malt Beverages).

Name

Address

Gallons sold

during period

1 Subtotal ............................................................................................................................................................

2 Total

............................................................................................

(from back page and attached additional sheets)

3 Total gallons sold during period

...................................

(add lines 1 and 2; enter here and on Form MT-50, line 11)