Form Tp-102 - Tobacco Product Tax Credit - 2005 Page 3
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4Schedule A - Sales to out-of-state retailers
For the period of ___________________________________________
Business name ____________________________________________ Phone _________________________
Out-of-state retailer
Wholesale cost
Moist snuff
of other tobacco
Invoice
Gross value of
total weight
products
(oz)
number
invoice
(B)
(A)
Owner’s name
Store physical address
Phone
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
$
$
oz
Total wholesale cost – Total value of column A on line 1, section 1, and column B on line 2, section 1 .........................
$
oz
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Parent category: Financial