Form 70-020 - Brand Specific Report For The Second Quarter 2006 Page 2

Download a blank fillable Form 70-020 - Brand Specific Report For The Second Quarter 2006 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 70-020 - Brand Specific Report For The Second Quarter 2006 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Reset Form

Brand Specific Report for Cigarette, Little Cigar and Roll-Your-Own

Iowa Department of Revenue

Product with Iowa Tax Paid for ALL Manufacturers

April

June 2006

July 20, 2006

Report for the Months of

through

Due Date:

Penalty for first late-filed return: $200

Permit No: ____________________________

MAIL THIS FORM TO:

1 Name ___________________________________________________

Iowa Department of Revenue

2 Address _________________________________________________

PO Box 10456

3 City, state, zip ____________________________________________

Des Moines, IA 50306-0456

4 E-mail __________________________________________________

Telephone: 515/281-8023 Fax: 515/281-3756

Brand specific manufacturer information for actual amount of product sold in Iowa

Please include all purchases of all brands of cigarettes, including little cigars and roll-your-own tobacco products sold in Iowa. This includes brands of

signatories of the Master Settlement Agreement (Participating Manufacturers) and brands of all Non-Participating Manufacturers (NPM). Select only one type

of product per page: cigarettes, little cigars or roll-your-own products. Identify this at the top of each page. Circle either (O) Original Participating, (S)

Subsequent Participating or (N) Non-Participating for each manufacturer. Please check the National Association of Attorneys General Web site,

, under tobacco settlement documents, for a list of all participating manufacturers and brand names.

Brand Names: Please list only one entry for all types of the same brand. Do not split out into Lights, Kings, 100’s, Menthol, etc., for each brand.

NOTE: One total per brand per quarter is needed to be considered as complete. Incomplete reports will be sent back to the distributor for completion.

Please select type of product listed on THIS page (select only one):

Cigarettes

Little Cigars

Roll-Your-Own

None - No Iowa Purchases or Sales of the above three products

Number of sticks

Street address,

Manufacturer if different