Form Att-24 - Georgia Loose And Smokeless Tobacco Excise Tax Monthly Return Form - Georgia Department Of Revenue Page 4

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ATT-24 – SCHEDULE C
PAGE
OF
GEORGIA DEPARTMENT OF REVENUE
ALCOHOL & TOBACCO DIVISION
SUBMIT IN DUPLICATE
SCHEDULE OF LOOSE AND SMOKELESS TOBACCO DELIVERED TO CUSTOMERS LOCATED OUTSIDE GEORGIA
DISTRIBUTOR
CITY
RETURN FOR MONTH/YEAR OF:
INSTRUCTIONS:
1.
Each invoice of shipment involving physical movement to points outside the State of Georgia, is to be reported separately
and must be supported by attaching hereto a legible copy of sales invoice.
2.
Each credit memorandum issued for loose/smokeless tobacco returned by out-of-state customer must be entered as a
negative amount in brackets ( ) and deducted.
3.
A separate sheet must be completed for each state where deliveries were made during the month covered by this
schedule.
LINE #
INVOICE
INVOICE
DATE
SOLD TO
LOOSE TOBACCO
SMOKELESS
DATE
NUMBER
DELIVERED
(NAME / CITY)
(Wholesale Cost Price)
(Wholesale Cost Price)
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 3 of summary page)
$
$
S U B M I T I N D U P L I C A T E

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