Schedule E - Part I - Roll-Your-Own Tobacco Purchased, Acquired, Or Shipped Into Connecticut During The Month Page 6

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