Schedule E - Part I - Roll-Your-Own Tobacco Purchased, Acquired, Or Shipped Into Connecticut During The Month Page 6

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Schedule E - Part II, Subpart B
Additional Sheet Number ________ of _________
Additional Sheet
Roll-your-own Tobacco Purchased, Acquired, or Shipped Into Connecticut During the Month
Nonparticipating Manufacturer’s or
Brand(s) of Roll-your-own
Supplier’s Name, Address, and FEIN
Quantity
Net Weight of Each
Total Weight
First Purchaser’s Name, Address, and FEIN
Tobacco
Subtotal .........................................................................................................................................
(Enter total for Part II, Subpart B - Additional Sheet(s) on Schedule E - Part II, Subpart B, Line 2.)
Schedule E - Part I I, Subpart B, Additional Sheet (Rev. 01
Page 6 of 6

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