Form Op-182 - Vending Machine Report Cigarette Distributors And Dealers - Department Of Revenue Services Page 2
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1
2Schedule A
Vending machines purchased, acquired, or brought into Connecticut during this reporting month:
*Sales
Purchase
Premises Where Machine Is Located
From Whom Acquired
Date
Qty
Manufacturer
Model
Tax
Price
(Name and Address)
(Name and Address)
Paid
* Fill in this column: Use “V” if the tax was paid to vendor; Use “S” if the tax was paid directly by you to the State of Connecticut and reported on
Total
(Should agree with Page 1, Line 2)
a return; Use “O” if tax was not paid and explain fully below.
Explain here if tax was not paid:
Schedule B
Description of vending machines sold or otherwise disposed of:
Premises Where Machine Was Located
To Whom Sold or Transferred
Date
Qty
Manufacturer
Model
Selling Price
(Name and Address)
(Name and Address)
Total
(Should agree with Page 1, Line 4)
OP-182 (Rev. 12/01)
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