DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
DBPR Form AB&T
4000A-251-3
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
1940 NORTH MONROE STREET • TALLAHASSEE FL 32399-1022
OUT OF STATE CIGARETTE MANUFACTURER'S RETURN DETAIL REPORT
Permit No.
Name
of
For the Month of
20
Reporting Period
through
DETAIL OF RETURNS FROM FLORIDA DISTRIBUTORS
NUMBER OF PACKS
10's
20's
25's
Florida
Date
Permit No.
RETURNED BY (Name and Address)
Invoice No.
Received
Stamped
Unstamped
Stamped
Unstamped
Stamped
Unstamped
Transaction Total (Transfer total of stamped and unstamped to page 1, line 2 )