Form Pt-3 - Potato Tax Shipper'S Report

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PT
Maine Revenue Services
00
Potato Tax Shipper’s Report
*1125000*
Registration No.
Period Begin
Due Date
Period End
1. Entity Information
2.
OUT OF BUSINESS?
Date closed:
3.
OWNERSHIP OR NAME CHANGE?
Date
Explanation
4.
SOLD? Date
ADDRESS CHANGE?: Check here and make the appropriate changes to the preprinted address.
Do Not Use Red Ink!
Pounds
,
,
Total pounds received, sold or shipped during month for which this report is made
1.
.
,
Total Due
Tax at $ .06 per hundredweight
2.
,
.
Credits
Credit carry forward from prior period (attach credit memo).
3.
Amount
,
.
Line 2 minus line 3. Use line 5 if the result is a credit amount.
4.
Due
Credit
If line 2 minus line 3 is a credit amount, enter the amount to the right. If you
Due
,
.
wish a refund rather than a carryforward to the next period, check here.
5.
/
Mail To:
Maine Revenue Service
P.O. Box 1065
Augusta, ME 04332-1065
Print Name
Date
Phone #
Signature/Title
PT-3 Revised 09/2011
For assistance in completing this form, call (207) 624-9609

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