Form 70-020 - Brand Specific Report For The Second Quarter 2010 Page 3
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3Page ____ Name __________________________ Permit No. ____________________
2nd QTR 2010 Brand Specific Report
Please select type of product listed on THIS page (select only one):
Cigarettes
Little Cigars
Roll-Your-Own
Number of sticks
Street address,
Manufacturer if different
Type of
or ounces with
Purchased from
city, state, zip and country
than purchased from
Manufacturer
Brand
IA tax paid
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TOTAL FOR THIS PAGE
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IOWA
70-020b (03/24/10)
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Parent category: Business