Form 265-25 - Consolidated Monthly Cigarette Tax Report (25s Only) Page 2
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Reset Schedule B
FOR 25s ONLY
SCHEDULE B — STAMPED AND UNSTAMPED CIGARETTES RETURNED TO MANUFACTURER
NUMBER OF PACKAGES
INVOICE NUMBER(S)
SHIPMENT
RETURNED TO MANUFACTURER
NAME OF COMMON CARRIER
NAME OF MANUFACTURER
OF RETURNED CIGARETTES
DATE
UNSTAMPED
STAMPED
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
0
0
ENTER TOTAL ON FORM 265-25, (UNSTAMPED ON LINE 8 AND STAMPED ON LINE 16)
SCHEDULE B-1 — STAMPED CIGARETTES PURCHASED FROM ANOTHER LICENSED WHOLESALER
STATE/ST. LOUIS
STATE/JACKSON
NAME OF WHOLESALER
INVOICE NUMBER(S)
INVOICE DATE(S)
STATE ONLY
COUNTY
COUNTY
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ / ___ ___ / ___ ___ ___ ___
0
0
0
ENTER TOTALS ON FORM 265-25, LINE 12
SCHEDULE B-2 — UNSTAMPED CIGARETTES PURCHASED FROM ANOTHER LICENSED OR UNLICENSED WHOLESALER (ATTACH LIST IF ADDITIONAL SPACE REQUIRED)
LICENSE
NAME OF WHOLESALER
TOTAL PACKS
INVOICE NUMBER(S)
INVOICE DATE(S)
BRAND
NUMBER
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ / ___ ___ / ___ ___ ___ ___
0
0
ENTER TOTAL ON FORM 265-25, LINE 7
SCHEDULE B-3 — REPORT OF LOST CIGARETTES (INFORMATIONAL PURPOSES ONLY)
NUMBER OF PACKAGES
INVOICE NUMBER(S)
SHIPMENT
OF LOST CIGARETTES
NAME OF MANUFACTURER
OF LOST CIGARETTES AND DATE
NAME OF COMMON CARRIER
SHORTAGE
SHIPPED
STAMPED
UNSTAMPED
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
0
0
TOTAL
DOR 265-25 (05-2011)
MO 860-1419 (05-2011)
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