Att-24 Schedule A - Schedule Of Purchases Of Georgia Non-Tax Cigars, Little Cigars, And Loose And Smokeless Tobacco Purchases

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ATT-24 Schedule A (REV. 01/11)

SCHEDULE OF PURCHASES OF GEORGIA NON-TAX

GEORGIA DEPARTMENT OF REVENUE

PAGE ________ OF ________

CIGARS, LITTLE CIGARS, AND

PROCESSING CENTER

LOOSE AND SMOKELESS TOBACCO PURCHASES

P.O. BOX 740395

ATLANTA, GEORGIA 30374-0395

NAME OF DISTRIBUTOR

CITY

STATE

RETURN FOR THE MONTH AND YEAR OF

INSTRUCTIONS:

All purchases by distributors including transfers from all other distributors and federal military installations for the month should be entered on Schedule A.

INVOICE

DATE

PURCHASED FROM

LOOSE TOBACCO

SMOKELESS

LARGE CIGARS

LITTLE CIGARS

LINE #

DATE

NUMBER

RECEIVED

(Name of Supplier)