Other Tobacco Products Excise Tax Return Form Page 3
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1
2
3State of Nevada
Department of Taxation
Pursuant NRS 370A
"ROLL-YOUR-OWN" TOBACCO REPORT
(If additional space is needed, please photocopy the report before making entries)
Wholesaler
_________________________________________
For the Month of
OTP License No. _________________________________________
month/year
READ INSTRUCTIONS ON THE REVERSE SIDE OF THIS REPORT BEFORE PREPARING
A
B
C
D
Name and Address of First Importer of Foreign
Ounces of "Roll -Your- Own" Tobacco
Non-Participating Manufacturer Name and Address
Produced Tobacco
Brand Name
Sold in Nevada
OTP 03
03/31/2000
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