Form 4426-20- Out-Of-State Missouri Cigarette Wholesaler Monthly Cigarette Tax Report - Missouri Department Of Revenue, Taxation Bureau Page 2

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FOR 20s ONLY
SCHEDULE B — STAMPED CIGARETTES RETURNED TO MANUFACTURER
NUMBER OF PACKAGES OF STAMPED
CIGARETTES RETURNED TO MANUFACTURER
INVOICE NUMBER(S)
SHIPMENT
NAME OF COMMON CARRIER
NAME OF MANUFACTURER
OF RETURNED CIGARETTES
DATE
STATE/JACKSON
STATE/ST. LOUIS
STATE ONLY
COUNTY
COUNTY
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
ENTER TOTALS ON FORM 4426-20, LINE 8
SCHEDULE B-1 — STAMPED CIGARETTES PURCHASED FROM ANOTHER LICENSED WHOLESALER
STATE/
STATE/
INVOICE NUMBER(S)
INVOICE DATE(S)
NAME OF WHOLESALER
STATE ONLY
JACKSON
ST. LOUIS COUNTY
COUNTY
___ ___ /___ ___ / ___ ___ ___ ___
___ ___ /___ ___ / ___ ___ ___ ___
___ ___ /___ ___ / ___ ___ ___ ___
___ ___ /___ ___ / ___ ___ ___ ___
___ ___ /___ ___ / ___ ___ ___ ___
___ ___ /___ ___ / ___ ___ ___ ___
___ ___ /___ ___ / ___ ___ ___ ___
___ ___ /___ ___ / ___ ___ ___ ___
___ ___ /___ ___ / ___ ___ ___ ___
___ ___ /___ ___ / ___ ___ ___ ___
ENTER TOTALS ON FORM 4426-20, LINE 3
MO 860-2593 (12-2007)

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