Form Rv-F1307301 - Beer Wholesaler Territorial Designation printable pdf download

Form Rv-F1307301 - Beer Wholesaler Territorial Designation

TENNESSEE DEPARTMENT OF REVENUE

BEER WHOLESALER TERRITORIAL DESIGNATION

File with:

Date Filed

Commissioner,

Tennessee Department of Revenue

Andrew Jackson State Office Building

Nashville, Tennessee 37242

In accordance with Section 57-6-104, Tennessee Code Annotated, the following information partaining to the assigned territories

of beer wholesalers by manufacturers or importers is affirmed:

For newly established territories, date for filing to be not later than ten (10) days prior to the introduction of a brand in that

territory.

1. Name and address of manufacturer or importer:

2. Name, title and address of manufacturer or importer agent:

3. Brand(s) of beer offered for distribution. Indicate alcoholic content by weight. (a separate filing must be made for each brand

if handled by a different wholesaler):

4. Name and address of wholesaler:

5. Name of wholesaler principal:

6. Description of assigned territory. If a county or city is divided by this assignment, define in detail that part of the county or

city so assigned.

Signature & title of manufacturer or importer agent or representative

NOTARY PUBLIC

Signature & title of wholesaler

NOTARY PUBLIC

FOR DEPARTMENT OF REVENUE USE ONLY

Approved:

Effective Date:

INTERNET (3-12)

RV-F1307301 (3-12)

Form Rv-F1307301 - Beer Wholesaler Territorial Designation