Schedule A-3 - Tobacco Products Tax - Resident Distributor
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1Schedule A-3
Department of Revenue Services
PO Box 5018
Tobacco Products Tax - Resident Distributor
Hartford CT 06102-5018
Record of snuff tobacco products purchased, imported, received, or acquired in Connecticut
(Rev. 05/09)
Include the total of Schedule A-3 on Line 9 of Form OP-300, Tobacco Products Tax Return. Attach Schedule A-3 to the return.
Attach additional sheets if needed.
Name _________________________________________________
Period ending ____________________
CT Tax Registration Number ___________________________
Address _________________________________________________________________________________________________________________________________________
Purchased, Imported,
Seller’s
Weight Each
Total Weight
Invoice Number
Date
Received, or Acquired From
FEIN
Brand Name
Quantity
(in ounces)
(Col. 6 x 7)
Column 2
Column 1
Column 3
Column 4
Column 5
Column 6
Column 7
Column 8
Include this amount on Line 9 of Form OP-300.
Total
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