Form Att-24 - Georgia Loose And Smokeless Tobacco Excise Tax Monthly Return Form - Georgia Department Of Revenue Page 3

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ATT-24 – SCHEDULE B
PAGE
OF
GEORGIA DEPARTMENT OF REVENUE
ALCOHOL & TOBACCO DIVISION
SCHEDULE OF LOOSE AND SMOKELESS TOBACCO RETURNED TO MANUFACTURER
DISTRIBUTOR
CITY
RETURN FOR MONTH/YEAR OF:
INSTRUCTIONS:
1.
Each credit memorandum, issued by manufacturer for loose/smokeless tobacco returned to them, is to be reported
separately and must be supported by attaching hereto a legible copy of credit memorandum.
CREDIT
CREDIT
DATE
LINE #
SOLD TO
LOOSE TOBACCO
SMOKELESS
MEMO
MEMO
SHIPPED
(NAME AND ADDRESS)
(Wholesale Cost Price)
(Wholesale Cost Price)
DATE
NUMBER
1.
$
$
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
PAGE TOTALS (Enter grand totals on line 2 of summary page)
$
$

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