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LER LOCATED IN THE STATE OF GEORIGA Submit online at https://gtc.dor.ga.gov FOR FILING PERIOD (MM/DD/YYYY ): STATE OF GEORGIA LICENSE NUMBER: NAME OF PRODUCER OR SHIPPER: ADDRESS: CITY: STATE: ZIP CODE: INSTRUCTIONS 1. This report must be filed with the Georgia Department of Revenue, on or before the 15th of each calendar month. 2. List separately, on this form, each invoice of distilled spirits shipment made or caused to be made into or within the State of Georgia during the calendar month.

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