Form Htdm-W - Hard To Dispose Material Wholesale Tax Return - State Of Rhode Island Division Of Taxation

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HARD TO DISPOSE
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
MATERIAL WHOLESALE
DIVISION OF TAXATION - ONE CAPITOL HILL - STE 4 - PROVIDENCE, RI 02908-5802
TAX RETURN
HTDM-W
NAME
ADDRESS
CITY, STATE & ZIP CODE
I HEREBY CERTIFY THAT THIS RETURN, TO THE BEST OF MY KNOWLEDGE
AND BELIEF, IS A TRUE, CORRECT AND COMPLETE RETURN.
SIGNATURE OF OWNER, PARTNER OR AUTHORIZED AGENT
FORM HTDM-W
TITLE
DATE
REVD 04/2016
$
A. TOTAL AMOUNT DUE
FEDERAL IDENTIFICATION NUMBER
RETURN FOR MONTH ENDING

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