Form 800-D - Tobacco Products Tax Return Form Page 2

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800
)
for Form
TOB-SCHEDULE A (
D
S
A
CHEDULE
TIN / SSN : # ____________________
D
R
O
C
R
ISTRIBUTOR'S
ECORD
F
IGARETTES
ECEIVED
Page ___ of ___
Taxpayer Name
Reporting Period
Date
Name of Supplier
Invoice Number
Quantity (Number of Cigarettes)
Total Number of Cigarettes Received :
TOB DIST - Form 800 - D
ONTC
Revised: 2/12/2002
Schedule A

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