Schedule A-1 - Tobacco Products Tax - Resident Distributor

SCHEDULE A-1

STATE OF CONNECTICUT

DEPARTMENT OF REVENUE SERVICES

TOBACCO PRODUCTS TAX - RESIDENT DISTRIBUTOR

(Rev. 07/00)

Record of tobacco products purchased, imported, received or acquired in Connecticut

(Total of Schedule A-1 must be reported on Line 1 of Form OP-300, Tobacco Products Tax Return )

Schedule A-1 must be attached to Form OP-300

Name __________________________________________________ Period Ending _________________________________________

Address ________________________________________________ CT Tax Registration Number ______________________________

“Wholesale Sales Price” means the price at which the taxpayer purchased, imported, received or acquired the tobacco products.

DATE

WHOLESALE

RECEIVED

FROM WHOM PURCHASED OR ACQUIRED

INVOICE NO.

SALES

PRICE

TOTAL

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Parent category: Financial