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Montana Department of Revenue Dan Bucks Brian Schweitzer Director Governor Credit Form For Out of Stock Sale Items Store Number: City: Date: Agent Signature: For Office Use Only Note: Please fax completed form to (800) 332-6135, Option 3 - 1 Date Invoice Invoice NABCA Number # of Cases # of Cases Regular Sale Approved Ordered Ordered On Received On Ordered Received Price Price Customer Service (406) 444-6900 TDD (406) 444-2830 www.mt.gov/revenue

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