Schedule E - Part I - Roll-Your-Own Tobacco Purchased, Acquired, Or Shipped Into Connecticut During The Month Page 2

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Additional Sheet Number __________ of _________
Schedule E - Part I
Additional Sheet
Roll-Your-Own Tobacco Purchased, Acquired or Shipped Into Connecticut During the Month
Participating
Roll-your-own tobacco
Participating manufacturer’s name and address
Total weight
manufacturer’s FEIN
Net weight of each
brand family
Quantity
Subtotal .....................................................................................................
Enter total for Part I - Additional Sheet(s), on Schedule E - Part I, Line 2.
Schedule E - Part I, Additional Sheet (Rev. 10/08 )
Page 2 of 6

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