Cigarette Exporter'S Report Form - 2003
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1DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-210-1
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE FL 32399-1022
CIGARETTE EXPORTER'S REPORT
Prepare in TRIPLICATE. Submit ORIGINAL and FIRST COPY to the AUDITING OFFICE of the DIVISION OF ALCOHOLIC BEVERAGES AND
TOBACCO. SECOND COPY is to be retained by the licensee. This report and payment must be filed in accordance with the provisions of
Chapter 210, Florida Statutes, on or before the tenth day of the month following the month being reported. Make remittances payable to the
"Division of Alcoholic Beverages and Tobacco".
Name
Phone No. (
)
Permit No.
Address
City
FL Zip
Month Reported
Yr
Reporting Period
through
This report is true and correct to the best of my knowledge and belief and is submitted under penalty of perjury.
Typed or Printed Name
Authorized Signature
SUMMARY OF TRANSACTIONS
20s
25s
1.
Beginning Balance
2.
Received From Manufacturers
3.
Received From Others
4.
Miscellaneous
5.
Total To Be Accounted For (Lines 1, 2, 3, & 4)
6.
Withdrawals for Export
7.
Other Tax Exempt Withdrawals
8.
Taxable Withdrawals
9.
Miscellaneous
10.
Total Withdrawals (Lines 6, 7, 8, & 9)
11.
Ending Balance (Line 5 minus line 10)
12.
Actual Inventory
13. Over / Short (Lines 11 minus line 12)
G&P 03 AUD08/138/94
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