Ets Form 140 - Cigarette Wholesaler'S Monthly Report - 1999

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Wyoming Department of Revenue
122 West 25th Street (Herschler Building), Cheyenne, Wyoming 82002-0110
ETS Form 140 Revised 9/15/99
Cigarette Wholesaler's Monthly Report
License Number
SSN/EIN _______________ R eport for Month Ended
Company Name
Mailing Address
Business Location
City
State
ZIP Code
Cigarette Inventory Reconciliation (Packages):
(20)
(25)
Other
Total
1. Beginning inventory
2. Purchases
3. Cigarette packs available for sale
4. Deductions:
a. Exported from state
b. Sold on Wind River Reservation - Exempt (See Instructions)
c. Ending inventory - without Wyoming stamps
d. Ending inventory - stamped with Wyoming stamps
5. Total Deductions
6. Stamped packages sold/delivered
Stamp Settings Reconciliation:
Stamps
Settings
Total
7. Beginning stamp inventory
8. Stamps purchased during the month
9. Total stamps available
10. Deductions:
a. Stamps spoiled and returned to Department for credit
b. Unaccountable stamps
c. Ending inventory - stamp readings
d. Ending inventory - stamped packages
11. Total Deductions
12. Total stamped packs sold/delivered during the month
Taxable Cigarette Sales:
Packages
Packages
Purchaser
Purchaser's Location
(20)
(25)
Other
Size
(1) See Attached Wholesaler's Printout
(2)
(3)
(4)
(5)
Totals for This Page
Total Number of
Totals for Page 2
Packages of ALL Sizes
Grand Total
Sold During the Month
Under penalty of law, I declare that I have examined this report, including accompanying schedules and statements and, to the best of
my knowledge and belief, it is correct and complete.
Signed:
Title:

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