FORM                                          MASSACHUSETTS DEPARTMENT OF REVENUE
                TAX RETURN OF CERTAIN CORPORATIONS, ASSOCIATIONS AND ORGANIZATIONS ENGAGED
180                                           IN THE SALE OF ALCOHOLIC BEVERAGES
FEDERAL IDENTIFICATION NUMBER    BE SURE THIS RETURN COVERS    FOR YEAR
                                 THE CORRECT PERIOD
         IF INCORRECT, SEE INSTRUCTIONS. DO NOT ALTER.                                                         1.GROSS RECEIPTS
BUSINESS NAME
                                                                                                               2.TAX RATE                   .0057
BUSINESS ADDRESS
                                                                                                               3.TAX DUE 
CITY/TOWN                        STATE                ZIP                                                        (MULTIPLY LINE 1 BY LINE 2)

         Check here if this is a final return.                                                                 4.PENALTIES

                                                                                                               5.INTEREST

                                                                                                               6.TOTAL AMOUNT DUE
                                                                                                                 (ADD LINES 3, 4 AND 5)
Return is due with payment on or before the 15th day of April following the year indicated above. Make check
payable to Commonwealth of Mass. Mail to: Mass. Dept. of Revenue, PO Box 7012, Boston, MA 02204.
I declare under the penalties of perjury that this return (including any accompanying schedules and statements)
has been examined by me and to the best of my knowledge and belief is a true, correct and complete return.
Signature                        Title                     Date

         This form is solely for the use of corporations, associations or organizations which are licensed by any city or town
         in the Commonwealth to sell alcoholic beverages, as defined in MGL Ch. 138, Section 1, except those corporations
         subject to taxation under the provisions of MGL Ch. 63 and chartered veteran’s organizations maintaining quarters
         for the exclusive use of their members. In addition to the license fees otherwise provided, such corporations, asso-
         ciations or organizations shall be liable for, and pay annually to the Commonwealth, an excise on the gross receipts
         from the sale of alcoholic beverages under such license, and received during the preceding calendar year. The
         estimated payment provisions of Chapter 62B do not apply.
         “Gross receipts,” as defined in MGL Ch. 63A, are the total proceeds from the sale of any drink of alcoholic nature
         or content sold without any deduction therefrom on account of costs or expenses. See Letter Ruling 94-4 for more
         information.
         Note:Corporations organized under Chapter 180 of the Mass. General Laws and which are not exempt under Sec-
         tion 501 of the U.S. Internal Revenue Code are subject to taxation under Chapter 63. If the corporation is not exempt
         under Section 501 of the U.S.  IRC, do not use Form 180. File instead a regular corporation excise return, Form 355.