Brand Specific Report For Cigarette, Little Cigar And Roll-Your-Own Product With Iowa Tax Paid For All Manufacturers Form printable pdf download

Brand Specific Report For Cigarette, Little Cigar And Roll-Your-Own Product With Iowa Tax Paid For All Manufacturers Form

Brand Specific Report for Cigarette, Little Cigar and Roll-Your-Own

Iowa Department of Revenue

Product with Iowa Tax Paid for ALL Manufacturers

Report for the Months of _______________ through _________________ , 2003

Due Date: July 20, 2003

April

June

Penalty for first late-filed return: $200

Permit No:

Brand specific manufacturer information for actual amount of product sold in Iowa

Please include all purchases of all brands of cigarettes, including little cigars and roll-your-own tobacco products sold in Iowa. This includes brands of

signatories of the Master Settlement Agreement (Participating Manufacturers) and brands of all Non-Participating Manufacturers (NPM). Select only one type

of product per page: cigarettes, little cigars or roll-your-own products. Identify this at the top of each page. Circle either (P) Participating or (N) Non-

Participating for each manufacturer. Please check the National Association of Attorneys General Web site, , under tobacco settlement

documents, for a list of all participating manufacturers and brand names.

Brand Names: Please list only one entry for all types of the same brand. Do not split out into Lights, Kings, 100’s, Menthol, etc., for each brand.

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