Form Tob: T-Whsle - Monthly Report By Resident Wholesale Dealers In Cigarette Products - 2005 Page 3

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NONTAXABLE SALES AS PROVIDED BY LAW
PART III – Sales To National Guard Units
CIGARETTES ONLY
EXEMPTION
INVOICE
INVOICE
TO WHOM SOLD
(a)
(b)
CERTIFICATE
DATE
NUMBER
(NAME AND ADDRESS)
NUMBER OF
TAX VALUE
NUMBER
CIGARETTES
(Col. a x $0.02125)
0
TOTALS (Enter here and also on Part I, line 4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PART IV – Sales To U.S. Government (Include Military Bases, Federal Prisons, and Indian Reservations)
CIGARETTES ONLY
INVOICE
INVOICE
TO WHOM SOLD
(a)
(b)
DATE
NUMBER
(NAME AND ADDRESS)
NUMBER OF
TAX VALUE
CIGARETTES
(Col. a x $0.02125)
0
TOTALS (Enter here and also on Part I, line 5). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If additional space is needed, attach additional sheets with identical headings. A computer printout with identical headings is
acceptable; however, totals should be entered on this page.

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