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Get NC DoR B-C-775 2015

(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS) FEIN or SSN Street Address City State NCDOR ID/Account Number Zip Code State of Domicile Name of Contact Person Phone Number Fill in circle if applicable: Fax Number Amended Return Computation of Tax on Spirituous Liquor/Antique Spirituous Liquor Sales and Mixed Beverages Surcharge 1. Total Retail Sales of Spirituous Liquor/Antique Spirituous Liquor 2. a. 1 or 5 bottle charge 2a. b. Additional 1 or 5 bottle charg.

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