Form L-922 - Monthly Tobacco Tax Return - 2010 Page 2

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SOUTH CAROLINA DISTRIBUTORS TRANSACTION REPORT
NON TAX PAID CIGARETTES/OTHER TOBACCO PRODUCTS
SCHEDULE B
NOTE: Cigarettes are recorded in packs and other tobacco products are recorded in dollars (purchase price).
OTHER
TOBACCO
CIGARETTES
PRODUCTS
NAME OF MANUFACTURER
20S
25S
NAME OF MANUFACTURER
$
$
$
$
$
$
$
Total packs/product received from
all sources. Carry to page 1, line 2,
Columns A, B, and C.
$
SCHEDULE C
Cigarettes/other tobacco products distributed exempt from South Carolina excise tax (i.e. Federal Government,
other states, other S.C. licensed distributors). List by total packs.
OTHER
CIGARETTES
TOBACCO
NAME OF
PRODUCTS
NAME, STATE
20S
25S
MANUFACTURER
North Carolina
$
Georgia
$
Tennessee
$
Kentucky
$
Federal Government
$
Other (list)
$
$
$
Total of all packs/product invoiced exempt. Carry
to page 1, line 4, Columns A, B, and C.
$
40642027
Page 2

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