OUT-OF-STATE TOBACCO PRODUCTS DISTRIBUTOR'S REPORT DETAIL
Permit Name
of
FL
For the Month of
20
Reporting Period
through
PRODUCT TRANSACTIONS
Wholesale
Date
Invoice Number
Name and Address of Florida Retailer
Sales Price
Transaction Total
(Transfer all transaction totals to applicable line on Summary Page)
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
DBPR Form AB&T
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
4000A-305-2
1940 NORTH MONROE STREET, TALLAHASSEE, FL 32399-1022
Rev. 12/03