STATE OF DELAWARE
SCHEDULE OTP-D
MONTH OF __________________________, 20___
DIVISION OF REVENUE
RESIDENT OR NONRESIDENT DISTRIBUTOR
820 NORTH FRENCH ST.
TOBACCO PRODUCTS SOLD TO EXEMPT ORGANIZATIONS
P.O. BOX 8911
WILMINGTON, DE 19899-8911
NAME: _________________________________________
EMPLOYER IDENTIFICATION NUMBER: _____________________________________
DATE
INVOICE
INVOICE
NAME & ADDRESS OF EXEMPT ORGANIZATION
WHOLESALE PRICE
SHIPPED
NUMBER
DATE
TOTAL $