Form Att-75 - Georgia Cigar Excise Tax Monthly Return Page 2

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ATT-75 (REV 7/03) – SCHEDULE A
GEORGIA DEPARTMENT OF REVENUE
PAGE
OF
ALCOHOL & TOBACCO DIVISION
SCHEDULE OF GEORGIA NON-TAX CIGAR PURCHASES
LICENSEE
CITY
RETURN FOR THE MONTH AND YEAR OF
INSTRUCTIONS:
Each invoice of purchase is to be reported separately, and all invoices from a particular cigar supplier should
be listed together in a group, and in addition each supplier should be listed in alphabetical order.
LINE #
INVOICE
INVOICE
DATE
PURCHASED FROM
LITTLE CIGARS
LARGE CIGARS
DATE
NUMBER
RECEIVED
(Name of Supplier)
(Quantity)
(Wholesale Cost Price)
1.
$
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
$
25.
PAGE TOTALS (Enter Grand Totals on Line 1 of Summary Page)

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