Instate Cigarette Importers Receipt Detail Report Form

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DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-255-2
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
1940 NORTH MONROE STREET • TALLAHASSEE FL 32399-1022
INSTATE CIGARETTE IMPORTER'S RECEIPT DETAIL REPORT
Permit No.
Name
of
FL
For the Month of
Yr
Reporting Period
through
DETAIL OF RECEIPTS
NUMBER OF PACKS
Entry
Cigarette
Country of
Entry No.
Date
Commercial
Origin
(7501)
(7501)
Name and Address of Supplier
Invoice No.
10's
20's
25's
(7501)
Transaction Total (Transfer total to line 2 on page 1)
NOTE: Attach copies of 7501's & Commercial Invoices

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