Form Tp-102 - Tobacco Product Tax Credit - 2005 Page 4
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4Schedule B - Tobacco products returned to manufacturer
For the period of ___________________________________________
Business name ____________________________________________ Phone _________________________
Manufacturer
Value of other
Weight of moist
tobacco products
snuff on memo
Date of
Credit memo
on memo
(oz)
memo
ID
(B)
(A)
Name
Address
Phone
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
$
oz
Total manufacturer refund credit value –
Total value of column A on line 3, section 1, and column B on line 4, section 1 ..................................................... $
oz
318
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