Schedule E - Part I - Roll-Your-Own Tobacco Purchased, Acquired, Or Shipped Into Connecticut During The Month Page 4

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