Schedule E - Part I - Roll-Your-Own Tobacco Purchased, Acquired, Or Shipped Into Connecticut During The Month Page 2
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6Schedule E - Part I
Additional Sheet Number ________ of _________
Additional Sheet
Roll-your-own Tobacco Purchased, Acquired Or Shipped Into Connecticut During The Month
Participating
Participating Manufacturer’s Name and Address
Brand(s) of Roll-your-own Tobacco
Total Weight
Net Weight of Each
Manufacturer’s FEIN
Quantity
Subtotal ...................................................................................................
(Enter total for Part I - Additional Sheet(s) on Schedule E - Part I, Line 2.)
Schedule E - Part I, Additional Sheet (Rev. 01/05)
Page 2 of 6
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