Schedule H - Part I - Cigarette Packages Stamped During The Month Page 6

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Schedule H - Part II, Subpart B
Additional Sheet Number ________ of _________
Additional Sheet
Cigarette Packages Stamped During the Month
Supplier’s Name, Address, and FEIN
Cigarette Brand Family
Nonparticipating Manufacturer’s or First Purchaser’s
Number of Connecticut Tax Stamps Affixed
Name, Address, and FEIN
20’s
25’s
Subtotal ............................................................................................................................................
Enter total for Part II, Subpart B - Additional Sheet(s) on Schedule H - Part II, Subpart B, Line 2.
Schedule H - Part II, Subpart B, Additional Sheet - (Rev. 02/07)
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