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S-3V - Registerable Motor Vehicle other than Cars and Trucks

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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 Date Number 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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  • 1. 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 Date Number 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