Subjobbers Quarterly Report Of Tax-Paid Tobacco Products Purchased Form - State Of Wisconsin Page 2

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If you have questions or need more reporting forms . . .
• Call (608) 266-8970
• Fax (608) 261-7049
• E-mail: excise@dor .st ate.wi.us
Wis. Permit No.
Invoice
Purchased From
City
Invoice Price
(TPD or TPJ)
Enter 4 digit #
Line
Number
Date
$
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
If additional sp ace is necessary to list all your purchases, att
ach a schedule and enter the subtot al of those
55
purchases on this line.
$
56
SUBT OT AL - Add lines 21 through 55. Enter here and on line 19 on the front of this form.
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