Vermont Department of Taxes
PO Box 547 Montpelier, VT 05601-0547
*146051100*
Phone: (802) 828-6839
VT Form
MALT BEVERAGE TAX RETURN
MB-605
* 1 4 6 0 5 1 1 0 0 *
This form, together with your check, is due on or before the 10th of each month to cover the preceding month.
Licensed Distributor
Federal ID Number
d/b/a (if applicable)
VT State Distributor License Number
Address
Reporting Period End Date (MMDDYYYY)
City
State
ZIP Code
Daytime Telephone Number
E-mail Address
Fax Number
1. If this is an amended return, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
2. If you are no longer in business, enter your final date of operations . . . . . . 2. ________________________
TAX COMPUTATION SCHEDULE
D
A
B
C
Tax Due
Type of malt beverage sold
Number of gallons sold
Tax Rate
(Multiply Column B by Column C)
3. Taxable malt
6% or less alcohol
$0.265
$
0.00
4. Taxable malt
over 6% alcohol
$0.55
$
0.00
5. Total Malt Beverage Tax Due (Add Column D, Lines 3-4)
Make check payable to Vermont Department of Taxes
0.00
$
Signature
I hereby certify that this return has been examined by me, and to the best of my knowledge, is a true and
complete return for the month stated, pursuant to 7 V.S.A. § 421.
Signature
Title
Date
Printed Name
Clear ALL fields
Important Printing Instructions
Print
Form MB-605
(formerly MB-1)
5454
Rev. 09/14