Cigarette Tax Worksheet - Montana Department Of Revenue Page 3

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Schedule A - Cigarette wholesaler purchasing recap

For the month of ________________________, 20 _____

Business name _____________________________________________ License Number _________________

•

In-state wholesaler must detail all purchases

•

Out-of-state wholesaler should only list products shipped into Montana

Number of unstamped cigarettes (include complimentary cigarettes)

(A + B + C +

(A)

Other cigarette manufacturer

D + E + F = G)

Brown &

(B)

(C)

(D)

(E)

(F)

Date

Invoice

Total sticks

Williamson

Ligget

Lorillard

Philip Morris

R.J. Reynolds

Manufacturer

Cigarette

Qty

Rec’d

(X1000)

name

brand name

(X1000)

Total this page – Total column G add values from this page only ..........................................................................................................................

Total all pages – Total all value from all pages, fill on last page only, total value on line 2, section 1 ................................................................

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