Form 4791 - Tobacco Products - Other Than Cigarettes Retailer Tax-Paid Purchases From Missouri Licensed Wholesalers - Schedule F Page 2

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PAGE 2
FORM 4791
$
Enter total from page 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MANUFACTURER’S INVOICE PRICE
INVOICE DATE INVOICE NUMBER
FROM WHOM PURCHASED
ADDRESS (CITY, STATE, ZIP)
(BEFORE DISCOUNTS AND/OR DEALS)
$
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Enter total on Line 2 on Form 4341 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
MO 860-2859 (11-2007)

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